Increases in weight and body size increase the odds for hypertension during 7 years of follow-up

Causal Relationship Between Branched-Chain Amino Acids and Hypertension: A Mendelian Randomization Study

BACKGROUND

This study aimed to investigate the causal relationships between branched-chain amino acids (BCAAs) and the risks of hypertension via meta-analysis and Mendelian randomization analysis.

METHODS AND RESULTS

A meta-analysis of 32 845 subjects was conducted to evaluate the relationships between BCAAs and hypertension. In Mendelian randomization analysis, independent single-nucleotide polymorphisms associated with BCAAs at the genome-wide significance level were selected as the instrumental variables. Meanwhile, the summary-level data for essential hypertension and secondary hypertension end points were obtained from the FinnGen study. As suggested by the meta-analysis results, elevated BCAA levels were associated with a higher risk of hypertension (isoleucine: summary odds ratio, 1.26 [95% CI, 1.08-1.47]; leucine: summary odds ratio, 1.28 [95% CI, 1.07-1.52]; valine: summary odds ratio, 1.32 [95% CI, 1.12-1.57]). Moreover, the inverse variance-weighted method demonstrated that an elevated circulating isoleucine level might be the causal risk factor for essential hypertension but not secondary hypertension (essential hypertension: odds ratio, 1.22 [95% CI, 1.12-1.34]; secondary hypertension: odds ratio, 0.96 [95% CI, 0.54-1.68]).

CONCLUSIONS

The increased levels of 3 BCAAs positively correlated with an increased risk of hypertension. Particularly, elevated isoleucine level is a causal risk factor for essential hypertension. Increased levels of leucine and valine also tend to increase the risk of essential hypertension, but further verification is still warranted.

To what extent the weight changes impact the risk of hypertension among menopausal women: insights from Tehran lipid and glucose study

BACKGROUND & AIM

The association between weight change and incident hypertension (HTN) in menopausal women has not been well characterized. This study aimed to determine whether weight changes after menopausal years make a difference in incidents of hypertension.

MATERIALS & METHODS

This population-based study was performed using data collected from Tehran Lipid and Glucose Study cohort (1999-2018). Women who had natural and early menopause were followed up every 3 years. Data gathering was performed through the standard protocol of the study. Statistical analysis was performed using multivariable Cox hazard regression analysis. We used the 'survival' package in the R software version 3.6.0 to fit survival models.

RESULTS

A total of 487 menopausal women met the inclusion criteria; 62.6% had natural menopause and remained had early menopause. Among the participants, 65.5% experienced HTN. The highest proportion of participants had > 5% weight gain, while the lowest had 3-5% weight gain. Either losing body weight (lost > 5%: HR: 0.44; CI 95%, 0.32, 0.62; p < 0.001), (lost 3-5%; HR: 0.47; CI 95%, 0.26, 0.84; p = 0.01), and weight gain > 5% (HR: 0.69; CI 95%, 0.51, 0.91; p = 0.01), were associated with decreased risk of HTN after adjustment for confounders. In this study, weight loss and gain have a protective impact on the development of HTN in subjects. For incident HTN, age (HR: 1.04 (1.01, 1.08), p = 0.004), fasting blood glucose (HR: 1.01, CI 95%:1.00, 1.01; p < 0.001), body mass index (1.02 (1.00, 1.05), p = 0.03) and smoking (1.70 (1.11, 2.58), p = 0.01) were positively associated with HTN.

CONCLUSIONS

Our study indicates the significant association of weight change with hypertension risk in later life among menopausal women.

Change in Body Mass Index and Attributable Risk of New-Onset Hypertension Among Obese Living Kidney Donors

OBJECTIVE

To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension.

BACKGROUND

Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown.

METHODS

Nested case-control study among 1558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years; interquartile range: 2.0-9.4) and 3783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y; interquartile range: 5.3-15.8). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification.

RESULTS

Overall, LKDs and nondonors had similar hypertension incidence [incidence rate ratio (IRR): 1.16, 95% confidence interval (95% CI): 0.94-1.43, P =0.16], even after adjusting for BMI change (IRR: 1.25, 95% CI: 0.99-1.58, P =0.05). Although LKDs and nondonors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95% CI: 0.46-1.34, P =0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95% CI: 1.15-2.29, P =0.006; relative excess risk due to interaction: 0.90, 95% CI: 0.24-1.56, P =0.007), such that LKDs who gained weight had higher hypertension incidence than similar nondonors (IRR: 1.83, 95% CI: 1.32-2.53, P <0.001).

CONCLUSIONS

Overall, LKDs and nondonors with obesity had similar hypertension incidence. Weight stability and loss were associated with similar hypertension incidence by donor status. However, LKDs who gained >5% saw increased hypertension incidence versus similar nondonors, providing support for counseling potential LKDs with obesity on weight management postdonation.

Primary Prevention of Weight Gain Among New Bus Operators: Results of the "Success & Health Impacts For Transit operators during Onboarding" (SHIFT Onboard) Pilot Study

OBJECTIVE

This study aimed to test the feasibility and efficacy of an enhanced onboarding intervention to prevent weight gain and support the early job success of new bus operators.

METHODS

Control participants ( n = 9) completed usual practice new employee training and onboarding. Intervention participants ( n = 14) completed five supplemental trainings and four online challenges during their first year. Primary outcomes were body weight, dietary behaviors, physical activity, and sleep duration/quality. Early job success was evaluated with measures of newcomer adjustment.

RESULTS

The difference between intervention and control participants in body weight change at 12-month was -6.71 lb (Cohen's d = -1.35). Differences in health behavior changes were mixed, but newcomer adjustment changes favored the intervention group.

CONCLUSIONS

Results support the feasibility of enhanced onboarding for bus operators to prevent worsening health while simultaneously advancing their success as new employees.

Gender-specific predictive ability for the risk of hypertension incidence related to baseline level or trajectories of adiposity indices: a cohort study of functional community

BACKGROUND

Early prevention of hypertension is important for global cardiovascular disease morbidity and mortality. This study aims to explore better predictors for hypertension incidence related to baseline level or trajectories of adiposity indices, as well as the gender-specific effect.

METHODS

6085 subjects from a functional community cohort in urban Beijing participated in our study. Restricted cubic splines were used to estimate nonlinear associations of body mass index (BMI) and waist-to-height ratio (WHtR) as continuous variable with risk of hypertension. Stepwise logistic regression model was performed to estimate the relative risks (RRs) of adiposity indices and metabolic status, adjusted for covariates. Nomogram models and receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive power of BMI trajectory groups and WHtR trajectory groups on hypertension incidence. Further, all analysis were performed by gender.

RESULTS

The risk of hypertension incidence was related to BMI trajectory groups (persistent overweight: RR = 1.88, 95% CI: 1.48-2.37; persistent obesity: RR = 2.79, 95% CI: 2.18-3.56; persistent the highest: RR = 4.30, 95% CI: 3.20-5.78) and WHtR trajectory groups (persistent medium: RR = 2.69, 95% CI: 2.07-3.50; persistent high: RR = 3.85, 95% CI: 2.92-5.09; increasing to higher: RR = 7.00, 95% CI: 4.96-9.89). In total population, BMI trajectories and WHtR trajectories showed similar ability to predict the risk of hypertension incidence with AUC 0.723 and 0.726, respectively. After stratified by gender, both BMI trajectories and WHtR trajectories showed higher power in female than male (BMI trajectories: 0.762 vs. 0.661; WHtR trajectories: 0.768 vs. 0.661).

CONCLUSIONS

BMI and WHtR trajectories have higher predictive power for hypertension incidence compared to baseline data. Females are more vulnerable to obesity than males.

Trajectories of body mass index and risk of incident hypertension among a normal body mass index population: A prospective cohort study

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.

Relative Telomere Length in Peripheral Blood Cells and Hypertension Risk among Mine Workers: A Case-Control Study in Chinese Coal Miners

Hypertension is a common chronic disease in middle-aged and elderly people and is an important risk factor for many cardiovascular diseases. Its pathogenesis remains unclear. Epidemiological studies have found that the loss of telomere length in peripheral blood cells can increase the risk of coronary heart disease, myocardial infarction, and other diseases. However, a correlation between loss of telomere length and hypertension has not been established. In this study, we aimed to explore the association between telomere length and the risk of essential hypertension (EH) in Chinese coal miners. A case-control study was performed with 215 EH patients and 222 healthy controls in a large coal mining group located in North China. Face-to-face interviews were conducted by trained staff with the necessary medical knowledge. Relative telomere length (RTL) was measured by a quantitative real-time PCR assay using DNA extracted from peripheral blood. In the control group, the age-adjusted RTL was statistically significantly lower in miners performing hard physical labour compared with nonphysical labour (P = 0.043). A significantly shorter age-adjusted RTL was found in the control group of participants who consumed alcohol regularly compared with those who do not consume alcohol (P = 0.024). Age-adjusted RTL was negatively correlated with body mass index (BMI) and alcohol consumption. Hypertension was also found to be significantly correlated with factors such as age, BMI, alcohol consumption, smoking, and tea consumption. Our results suggest that RTL is associated with hypertension in coal miners.

Body Mass Index Trajectories During Young Adulthood and Incident Hypertension: A Longitudinal Cohort in Chinese Population

Background This longitudinal study aims to characterize longitudinal body mass index ( BMI ) trajectories during young adulthood (20-40 years) and examine the impact of level-independent BMI trajectories on hypertension risk. Methods and Results The cohort consisted of 3271 participants (1712 males and 1559 females) who had BMI and blood pressure ( BP ) repeatedly measured 4 to 11 times during 2004 to 2015 and information on incident hypertension. Four distinct trajectory groups were identified using latent class growth mixture model: low-stable (n=1497), medium-increasing (n=1421), high-increasing (n=291), sharp-increasing (n=62). Model-estimated levels and linear slopes of BMI at each age point between ages 20 and 40 were calculated in 1-year intervals using the latent class growth mixture model parameters and their first derivatives, respectively. Compared with the low-stable group, the hazard ratios and 95% CI were 2.42 (1.88, 3.11), 4.25 (3.08, 5.87), 11.17 (7.60, 16.41) for the 3 increasing groups, respectively. After adjusting for covariates, the standardized odds ratios and 95% CI of model-estimated BMI level for incident hypertension increased in 20 to 35 years, ranging from 0.80 (0.72-0.90) to 1.59 (1.44-1.75); then decreased gradually to 1.54 (1.42-1.68). The standardized odds ratio s of level-adjusted linear slopes increased from 1.22 (1.09-1.37) to 1.79 (1.59-2.01) at 20 to 24 years; then decreased rapidly to 1.12 (0.95-1.32). Conclusions These results indicate that the level-independent BMI trajectories during young adulthood have significant impact on hypertension risk. Age between 20 and 30 years is a crucial period for incident hypertension, which has implications for early prevention.

Everyday Discrimination Prospectively Predicts Blood Pressure Across 10 Years in Racially/Ethnically Diverse Midlife Women: Study of Women's Health Across the Nation

BACKGROUND

Interpersonal discrimination is linked to greater risk for cardiovascular disease (CVD) and this association varies by race/ethnicity.

PURPOSE

To examine whether exposure to everyday discrimination prospectively predicts elevated blood pressure (BP), whether this association differs by race/ethnicity, and is mediated by adiposity indices.

METHODS

Using data for 2,180 self-identified White, Black, Chinese, Japanese, and Hispanic participants from the Study of Women's Health Across the Nation, we examined associations among exposure to (higher vs. lower) everyday discrimination at baseline and BP and hypertension (HTN; systolic blood pressure [SBP] ≥ 140 mmHg; diastolic blood pressure [DBP] ≥ 90 mmHg; or self-reported HTN medication use) risk over a 10 year period. Additionally, we used the bootstrap method to assess repeated, time-varying markers of central and overall adiposity (waist circumference and body mass index [BMI] (kg/m2), respectively) as potential mediators.

RESULTS

Exposure to everyday discrimination predicted increases in SBP and DBP over time, even after adjusting for known demographic, behavioral, or medical risk factors. However, greater waist circumference or BMI (examined separately) mediated these observations. Notably, there were no racial/ethnic differences in the observed association and HTN risk was not predicted.

CONCLUSIONS

The current findings suggest that everyday discrimination may contribute to elevated BP over time in U.S. women, in part, through increased adiposity. These findings demonstrate the complexity of the linkage of discrimination to CVD risk and raise the need to closely examine biobehavioral pathways that may serve as potential mediators.

Effects of Exercise Training during Christmas on Body Weight and Cardiometabolic Health in Overweight Individuals

Individuals with abdominal obesity and metabolic syndrome (MetS) have augmented risk of all-cause mortality. Lifestyle interventions are effective to treat MetS, however, there are periods during the year in which exercise programs are discontinued and improper dietary habits reappear (e.g., Christmas holidays). We aimed to analyze if exercise-training during Christmas holidays would avoid body-weight gains and cardiometabolic deterioration in MetS individuals, using a randomized control trial. Thirty-eight men with MetS undergoing exercise training were randomly allocated to either continue (TRAIN group, n = 16) or discontinue (HOLID group, n = 22) training, during the three weeks of Christmas. Anthropometrics (body weight, fat, and waist circumference), fasting blood metabolites (glucose, insulin, triglycerides, and cholesterol concentrations) and exercise maximal fat oxidation (FO_MAX) and oxygen uptake (VO_2PEAK) were determined before and after Christmas. Both groups were similar at baseline in all parameters (p > 0.05). HOLID group increased body weight (91.3 ± 13.0 to 92.0 ± 13.4 kg, p = 0.004), mean arterial pressure (94.0 ± 10.6 to 97.1 ± 8.9 mmHg, p = 0.026), blood insulin (10.2 ± 3.8 to 12.5 ± 5.4 µIU·mL⁻¹, p = 0.003) and HOMA (3.2 ± 1.3 to 4.1 ± 2.3, p = 0.003). In contrast, TRAIN prevented those disarrangements and reduced total (170.6 ± 30.6 to 161.3 ± 31.3 mg·dL⁻¹, p = 0.026) and low-density lipoprotein cholesterol (i.e., LDL-_C, 104.8 ± 26.1 to 95.6 ± 21.7 mg·dL⁻¹, p = 0.013). TRAIN also prevented the reductions in exercise FO_MAX and VO_2PEAK that was observed in the HOLID group (p = 0.002). In conclusion, exercise training during Christmas, prevents body weight gains and the associated cardiovascular (increase in blood pressure and LDL_-C) and metabolic (reduced insulin sensitivity) health risks are an optimal non-pharmacological therapy for that period of the year.

Association of 6-year waist-circumference change with progression from prehypertension to hypertension: the Rural Chinese Cohort Study

Whether dynamic change in waist circumference is associated with progression from prehypertension to hypertension is not well understood. We explored this issue. A total of 4221 prehypertensive adults ≥18 years were enrolled during 2007-2008 and followed up during 2013-2014. Participants were classified by percentage waist-circumference change at follow-up: ≤-2.5, -2.5 to ≤2.5, 2.5 to ≤5.0, and >5.0%. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic regression models, with stable waist-circumference change (-2.5 to 2.5%) as the reference. During the 6 years of follow-up, 1464 prehypertensive patients (851 women) showed progression to hypertension, with an incidence rate of 32.7% for men and 36.3% for women. As compared with stable waist circumference, a waist-circumference gain > 5.0% was associated with increased hypertension risk: adjusted ORs (95% CI) were 1.08 (1.01-1.14) for men and 1.09 (1.04-1.15) for women. The risk also decreased significantly for men with ≥2.5% waist-circumference loss (OR = 0.94, 95% CI 0.88-1.00). We found a linear association between percentage waist-circumference gain and risk of progression from prehypertension to hypertension for both sexes by restricted cubic splines (p_nonlinearity = 0.772 for men and 0.779 for women). For each 10% gain in waist circumference, the risk increased by 8% for men and 5% for women. The association remained significant for both sexes in a subgroup analysis by abdominal obesity at baseline. The long-term gain in waist circumference significantly increased the risk of progression from prehypertension to hypertension for both sexes in a rural Chinese population, regardless of abdominal obesity status at baseline.

Combined association of cardiorespiratory fitness and family history of hypertension on the incidence of hypertension: a long-term cohort study of Japanese males

Family history of hypertension (FH) is a nonmodifiable risk factor for hypertension. However, cardiorespiratory fitness (CRF) is a modifiable risk factor and might be important for preventing hypertension in both people with and without FH. The purpose of this study was to investigate the combined association of CRF and FH on the incidence of hypertension in normotensive male Japanese workers. A total of 6890 workers were included in this study. CRF was determined using a submaximal exercise test. A self-reported questionnaire was used to determine FH. Six groups were established, combining the two groups with and without FH (Yes, No) and the three CRF groups (Low, Moderate, High). The incidence of hypertension, defined as systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg, or self-reported physician-diagnosed hypertension was evaluated. During the observation period of 101,212 man-years (median 17 years, minimum 1 year, maximum 23 years), 2210 workers developed hypertension. There were 3860 participants who had FH (56%). Compared with the Yes-Low CRF group, the HRs (95% CI) for hypertension were 66% lower in the No-High CRF group (0.34 [0.28-0.40]), 47% lower in the No-Low CRF group (0.53 [0.46-0.61]), and 24% lower in the Yes-High CRF group (0.76 [0.67-0.86]). FH and CRF did not show a significant interaction (p for interaction = 0.181). The combination of FH and CRF showed a clear association with the risk of incident hypertension, and moderate to high levels of CRF might be equally beneficial for preventing hypertension for both people with and without FH.

Effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China

BACKGROUND

The incidence of hypertension in China is high, which seriously affects people's health, including occupational population in mining areas. Cognitive dysfunction has a serious impact on the work and life of patients. Lifestyle intervention can improve diabetes and cardiovascular diseases. However, there are few studies on the effects of lifestyle interventions on cognitive function in hypertensive patients. So the aim of this study was to analyze the effect of long-term lifestyle intervention on mild cognitive impairment in hypertensive occupational population in China.

METHODS

In September 2013, a cluster sampling was conducted for the workers in the Shaanxi Jinduicheng (intervention group) and Hancheng (control group) mining areas. In both groups, according to the blood pressure (BP) level, they were divided into hypertension stage 1 to 3 subgroups; according to their age, they were divided into between 45 and 59 and under 45 years subgroups; and according to whether or not taking medicine, they were divided into Lifestyle intervention, Lifestyle intervention plus medication, Medication, and No lifestyle intervention nor medication subgroups. The intervention group received regular lifestyle intervention for 2 years, which included diet, smoke, drink, and exercise intervention. Mild cognitive impairment was measured by the Montreal Cognitive Assessment (MoCA). The arterial stiffness was measured by Omron Automatic Atherosclerosis Tester. We conducted BP measurement and MoCA questionnaire at baseline, 6, 12, and 24 months.

RESULTS

We analyzed a total of 510 mine workers, whose average age was 45.6 ± 13.4 years old. With the increase of BP level, the MoCA scores decreased significantly both in control and lifestyle intervention groups (P < .05). There was no obvious difference between the hypertensive patients whose age was between 45 and 59 to those under 45 in MoCA scores (P > .05). After 2 years, the BP, total cholesterol, glucose, and brachial-ankle pulse wave velocity of the Lifestyle intervention subgroup and Lifestyle intervention plus medication subgroup decreased (P < .05), and the MoCA scores and ankle-brachial index increased (P < .05), and the latter improved more significantly. Compared with the No lifestyle intervention nor medication subgroup, the BP and MoCA scores had no obvious changes at 6 months (P > .05), but the BP decreased and the MoCA scores increased significantly in the Lifestyle intervention and Lifestyle intervention plus medication subgroups after 1 and 2 years of lifestyle intervention (P < .05).

CONCLUSION

Long-term lifestyle intervention can be used as adjunctive therapy to improve the BP and cognitive function of hypertensive occupational population in China.

Body mass index, abdominal adiposity, weight gain and risk of developing hypertension: a systematic review and dose-response meta-analysis of more than 2.3 million participants

OBJECTIVE

This study aimed to test the association between anthropometric measures and risk of developing hypertension.

METHODS

We did a systematic search using PubMed and Scopus, from inception up to January 2017. Prospective cohort studies reporting the risk estimates of hypertension for three or more quantitative categories of indices of general and abdominal adiposity were included. Summary relative risks were calculated using random-effects models.

RESULTS

Fifty-seven prospective cohort studies were included. Summary relative risks were 1.49 (95% confidence interval [CI]: 1.41, 1.58; I²  = 97.4%, n = 50) for a five-unit increment in body mass index, 1.27 (95%CI: 1.15, 1.39; I²  = 95.0%, n = 14) for a 10-cm increment in waist circumference, 1.16 (95%CI: 1.09, 1.23; I²  = 77.8%, n = 5) for weight gain equal to a one-unit increment in BMI, and 1.37 (95%CI: 1.24, 1.51; I²  = 76.4%, n = 8) and 1.74 (95%CI: 1.35, 2.13; I²  = 58.9%, n = 4) for a 0.1-unit increment in waist-to-hip ratio and waist-to-height ratio, respectively. The risk of hypertension increased continuously with increasing all anthropometric measures, and also along with weight gain.

CONCLUSION

Being as lean as possible within the normal body mass index range may be the best suggestion in relation to primary prevention of hypertension.

Application of SCM with Bayesian B-Spline to Spatio-Temporal Analysis of Hypertension in China

Most previous research on the disparities of hypertension risk has neither simultaneously explored the spatio-temporal disparities nor considered the spatial information contained in the samples, thus the estimated results may be unreliable. Our study was based on the China Health and Nutrition Survey (CHNS), including residents over 12 years old in seven provinces from 1991 to 2011. Bayesian B-spline was used in the extended shared component model (SCM) for fitting temporal-related variation to explore spatio-temporal distribution in the odds ratio (OR) of hypertension, reveal gender variation, and explore latent risk factors. Our results revealed that the prevalence of hypertension increased from 14.09% in 1991 to 32.37% in 2011, with men experiencing a more obvious change than women. From a spatial perspective, a standardized prevalence ratio (SPR) remaining at a high level was found in Henan and Shandong for both men and women. Meanwhile, before 1997, the temporal distribution of hypertension risk for both men and women remained low. After that, notably since 2004, the OR of hypertension in each province increased to a relatively high level, especially in Northern China. Notably, the OR of hypertension in Shandong and Jiangsu, which was over 1.2, continuously stood out after 2004 for males, while that in Shandong and Guangxi was relatively high for females. The findings suggested that obvious spatial-temporal patterns for hypertension exist in the regions under research and this pattern was quite different between men and women.

The association of waist circumference with walking difficulty among adults with or at risk of knee osteoarthritis: the Osteoarthritis Initiative

OBJECTIVE

Excess weight is a known risk factor for functional limitation and common in adults with knee osteoarthritis (OA). We asked to what extent high waist circumference was linked with developing difficulty with walking speed and distance over 4 years in adults with or at risk of knee OA.

METHOD

Using data from the Osteoarthritis Initiative (OAI), we employed World Health Organization (WHO) categories for Body Mass Index (BMI) and waist circumference (small/medium and large). Difficulty with speed was defined by slow gait: <1.2 m/s during a 20-m walk, and difficulty with distance was defined by an inability to walk 400 m. We calculated risk ratios (RR) to examine the likelihood of developing difficulty with distance and speed using obesity and waist circumference as predictors with RRs adjusted for potential confounders (i.e., age, sex, race, education, physical activity, and OA status).

RESULTS

Participants with obesity and large waists were 2.2 times more likely to have difficulty with speed at 4 years compared to healthy weight and small/medium waisted participants (Adjusted RR 2.2 [95% Confidence interval (CI) 1.6, 3.1], P < .0001). Participants with obesity and a large waist circumference had 2.4 times the risk of developing the inability to walk 400 m compared with those with a healthy BMI and small/medium waist circumference (Adjusted RR 0.9 [95% CI 1.6, 3.7], P < .0001).

CONCLUSIONS

Waist circumference may be a main risk factor for developing difficulty with speed in adults with or at risk of knee OA.

Anthropometric measures change and incidence of high blood pressure levels among adults: a population-based prospective study in Southern Brazil

OBJECTIVE

The objective was to evaluate the effects of BMI and waist circumference change on the cumulative incidence of high blood pressure levels (HBP) among adults.

METHODS

Prospective longitudinal study in Southern Brazil, with a sample evaluated in 2009 (n = 1720) and 2012 (n = 1213). The incidence of HBP was estimated using measured values of systolic and diastolic arterial pressure (≥140/90 mmHg).

RESULTS

The prevalence of overweight (BMI ≥ 25 kg/m) was 47.3% in 2009 and 55.0% in 2012. The incidence of HBP was 32.0%. Being overweight or having an elevated waist circumference (top quartile) in the two waves increased the incidence of HBP [odds ratio 3.41 (95% confidence interval (CI) 2.10; 5.53) and 5.42 (95% CI 2.65; 11.08), respectively] compared with those always eutrophic. Being overweight in either wave also increased the risk of HBP, whereas reducing waist circumference was a protective factor. When the annual BMI and waist circumference change were evaluated (conditional to the baseline measurements, age, and sex) the adjusted predicted incidence of HBP was 46.5% (95% CI 36.9; 56.1) among individuals with an annual BMI change more than +1.0 kg/m, and 45.1% (95% CI 36.7; 53.4) among those with an annual waist circumference change more than +3.0 cm. Among those who reduced their BMI and waist circumference, the incidence of HBP were 25.9 and 23.8%, respectively.

CONCLUSION

Being overweight (in any wave), maintaining an elevated waist circumference, or having an annual rise of these measurements above the expected values, all increased the incidence of HBP. Reducing the waist circumference showed greater benefits for the prevention of HBP than BMI changes.

Weight Control Intervention for Truck Drivers: The SHIFT Randomized Controlled Trial, United States

OBJECTIVES

To evaluate the effectiveness of the Safety and Health Involvement For Truckers (SHIFT) intervention with a randomized controlled design.

METHODS

The multicomponent intervention was a weight-loss competition supported with body weight and behavioral self-monitoring, computer-based training, and motivational interviewing. We evaluated intervention effectiveness with a cluster-randomized design involving 22 terminals from 5 companies in the United States in 2012 to 2014. Companies were required to provide interstate transportation services and operate at least 2 larger terminals. We randomly assigned terminals to intervention or usual practice control conditions. We assessed participating drivers (n = 452) at baseline and 6 months.

RESULTS

In an intent-to-treat analysis, the postintervention difference between groups in mean body mass index change was 1.00 kilograms per meters squared (P < .001; intervention = -0.73; control = +0.27). Behavioral changes included statistically significant improvements in fruit and vegetable consumption and physical activity.

CONCLUSIONS

Results establish the effectiveness of a multicomponent and remotely administered intervention for producing significant weight loss among commercial truck drivers.

Changes in Body Weight From Young Adulthood to Middle Age and Its Association With Blood Pressure and Hypertension: A Cross-Sectional Study in Hong Kong Chinese Women

BACKGROUND

Few studies have examined the associations of weight changes from young adulthood to middle age with blood pressure (BP) and hypertension among Hong Kong Chinese women.

METHODS AND RESULTS

Weight at age 18 (W18), current weight (Wcurrent), height, BP, demographics, and lifestyle factors were obtained from 1253 female nurses (35-65 years) by a self-administered questionnaire through mail survey in Hong Kong. The conditional relative weight (CRW; a residual of Wcurrent regressed on W18) was used to express the relative weight change from age 18 to current age. The study results show that from young adulthood to middle age, 76.9%, 15.1%, and 8.0% of women had weight gain, weight loss, and stable weight, respectively. Women in the weight loss group had heavier W18 than those in the weight gain group (P<0.05). Higher weight gain was associated with higher BP (P for trend <0.01). Women who belonged to the heaviest 10% both at age 18 and at present had highest BP than women in other weight categories. By giving W18, a 1-kg increase in weight change predicted 0.63 and 0.42 mm Hg increases in systolic and diastolic BP, respectively (both P<0.001) and 12% greater odds of being hypertension (95% confidence interval, 1.08, 1.17). The CRW was positively associated with BP and hypertension; no interaction was found between CRW and Wcurrent on BP/hypertension.

CONCLUSIONS

A majority of Chinese women tended to become heavier throughout adult life. More weight gain led to the higher BP. Weight change is an independent predictor for later-life BP and hypertension.

Weight change after 20 years of age and the incidence of dyslipidemia: a cohort study of Japanese male workers

BACKGROUND

While heavier weight is known to increase the incidence of dyslipidemia, limited data are available on the relationship between weight gain and its development.

METHODS

A total of 2647 males were categorized into the following four groups according to the difference between their self-reported weight at 20 years of age and their measured weight in 1994-95: a loss of ≥5% (decrease), loss of <5% or gain of <5% (no change), gain of ≥5 to <15% (increase) and gain of ≥15% (sizable increase). They were followed up until their 2002-03 health examination. Using the 'no change' group as reference, the multivariable-adjusted odds ratio (adjusted for age, body mass index at 20 years of age, physical activity, smoking and alcohol intake) and 95% confidence interval (95% CI) for the incidence of dyslipidemia were determined using logistic regression models.

RESULTS

A total of 1342 participants developed dyslipidemia during the follow-up period. The 'increase' and 'sizable increase' groups had odds ratios for the incidence of dyslipidemia of 1.97 (95% CI, 1.59-2.45) and 2.68 (2.15-3.34), respectively, demonstrating that there was a significant dose-response association between weight gain since 20 years of age and the incidence of dyslipidemia (P < 0.001 for trend).

CONCLUSION

These results suggest that dyslipidemia could be prevented by avoiding weight gain in adulthood.

Cost-effectiveness of asenapine in the treatment of schizophrenia in Canada

OBJECTIVE

Asenapine is the first tetracyclic antipsychotic approved in Canada for the treatment of schizophrenia (SCZ). Asenapine has shown a comparable efficacy profile to other atypical antipsychotics and it is associated with a favourable metabolic profile and less weight gain. This study aimed to assess the economic impact of asenapine compared to other atypical antipsychotics in the treatment of SCZ in Canada.

METHODS

A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with other atypical antipsychotics. The decision tree takes into account the occurrence of extrapyramidal symptoms, the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases, and stroke. In the base-case analysis, asenapine was compared to olanzapine. Asenapine was also compared with other atypical antipsychotics commonly used in Canada in alternative scenarios. Analyses were conducted from both Canadian Ministry of Health (MoH) and societal perspectives over a 5-year time horizon.

RESULTS

In the treatment of SCZ, asenapine is a dominant strategy over olanzapine from both MoH and societal perspectives. Compared to quetiapine, asenapine is also a dominant strategy. Furthermore, asenapine has a favorable economic impact compared to ziprasidone and aripiprazole, as these antipsychotics are not cost-effective compared to asenapine from both MoH and societal perspectives.

CONCLUSION

Despite the short time horizon, the lack of compliance data and the assumptions made, this economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine and to most of the atypical antipsychotics frequently used in Canada.

Cost-effectiveness of asenapine in the treatment of bipolar disorder in Canada

BACKGROUND

Bipolar disorder (BPD) is prevalent and is associated with a significant economic burden. Asenapine, the first tetracyclic antipsychotic approved in Canada for the treatment of BPD, has shown a comparable efficacy profile to other atypical antipsychotics. In addition, it is associated with a favourable metabolic profile and minimal weight gain potential. This study aimed to assess the economic impact of asenapine compared to olanzapine in the treatment of BPD in Canada.

METHODS

A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with olanzapine. The decision tree takes into account the occurrence of extrapyramidal symptoms (EPS), the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases (CHDs), and stroke. Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a five-year time horizon with yearly cycles.

RESULTS

In the treatment of BPD, asenapine is a dominant strategy over olanzapine from both a MoH and a societal perspective. In fact, asenapine is associated with lower costs and more quality-adjusted life years (QALYs). Results of the probabilistic sensitivity analysis indicated that asenapine remains a dominant strategy in 99.2% of the simulations, in both a MoH and a societal perspective, and this result is robust to the many deterministic sensitivity analyses performed.

CONCLUSIONS

This economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine in the treatment of BPD in Canada.

[Impact of body mass index on men in their 20s and the effects of subsequent changes in body weight upon the rates of hypertension and diabetes and medical costs in their 40s]

OBJECTIVE

To investigate the impact of body mass index (BMI) of men in their 20s and the effects of subsequent changes in body weight upon medication rates, prevalence of hypertension and diabetes, and medical costs in their 40s.

SUBJECTS AND METHODS

A total of 10,125 men who were in their 20s in 1989 were recruited as subjects and grouped according to their BMI and a combination of BMI and increase in body weight over a 20-year period. A logistic regression analysis was performed to evaluate subsequent medication rates, prevalence of hypertension and diabetes, and consultation rate. Analysis of covariance was performed for mean medical costs on the basis of the BMI value in their 20s. All data were adjusted for age in 1989 and changes in body weight over the subsequent 20 yr.

RESULTS

A mean increase of 7 kg in body weight was observed over the 20-year period. Medication rates and prevalence of hypertension and diabetes in the men in their 40s increased significantly in correlation with the BMI values in their 20s (men with higher BMI showed higher medication and symptom prevalence rates). The 25.0 or higher BMI group showed a 6.81-fold higher prevalence of hypertension and a 16.62-fold higher prevalence of diabetes than the 18.5-19.9 BMI group. Similarly, men with higher BMI values in their 20s incurred greater outpatient and total medical costs in their 40s. The mean total medical costs in 2009 of men in the 18.5 or lower BMI group in their 20s was 818.7 yen and that for men in the 25.0 or higher BMI group was 5,311.5 yen. Furthermore, men in their 40s showed increased risk of hypertension and diabetes, if their body weight increased by 10 kg or more in the subsequent 20 yr, even when they had BMI values between 20.0 and 24.9 in their 20s.

DISCUSSION

Men with high BMI values in their 20s showed higher prevalence of hypertension and diabetes and incurred greater medical costs in their 40s. Even men with a BMI of less than 25.0 in their 20s, showed increases in the prevalence of hypertension and diabetes which were dependent on their weight gain in the subsequent years. Healthcare activities in Japanese corporations based on lifetime employment should promote anti-obesity strategies among young employees and help not only those employees who are obese but also those who are not controlling their weight.

Development of a pediatric body mass index using longitudinal single-index models

As a measure of human adiposity, the body mass index, defined as weight/height(2), has been widely used in clinical investigations. For children undergoing pubertal development, whether this function of height and weight represents an optimal way of quantifying body mass for assessing of specific health outcomes has not been carefully studied. In this study, we propose an alternative pediatric body mass measure for prediction of blood pressure based on recorded height and weight data using single-index modeling techniques. Specifically, we present a general form of partially linear single-index mixed effect models for the determination of this new metric. A methodological contribution of this research is the development of an efficient algorithm for the fitting of a general class of partially linear single-index models in longitudinal data situations. The proposed model and related model fitting algorithm are easily implementable in most computational platforms. Simulation demonstrates superior performance of the new method, as compared to the standard body mass index measure. Using the proposed method, we explore an alternative body mass measure for the prediction of blood pressure in children. The method is potentially useful for the construction of other indices for specific investigations.

Impact of obesity on incident hypertension independent of weight gain among nonhypertensive Japanese: the Ibaraki Prefectural Health Study (IPHS)

OBJECTIVE

The aim of this study was to examine the association between BMI and risk of incident hypertension among Japanese men and women who are middle-aged and older.

DESIGN

Prospective, population-based cohort study.

PATIENTS

A total of 68 205 nonhypertensive adults (18 336 men and 49 869 women) aged 40-79 years who completed health check-ups in the Ibaraki prefecture, Japan, in 1993 were followed up through 2006. To exclude the impact of BMI change during the follow-up period, a time-dependent covariate Cox proportional hazards model was used to compute the hazard ratios of incident hypertension according to BMI categories. Incident hypertension was defined as a SBP of at least 140 mmHg, a diastolic BP of at least 90 mmHg, and/or hypertensive medication use.

RESULTS

A total of 30 982 adults (45.4%) developed hypertension (9331 men and 21 651 women) during a mean of 3.9 years of follow-up. Compared with a BMI of less than 19.0, time-dependent covariates adjusted hazard ratios [95% confidence interval (CI)] for hypertension among participants with a BMI of at least 25.0 were 1.42 (1.17-1.73) for men aged 40-59 years, 1.34 (1.19-1.51) for men aged 60-79 years, 1.47 (1.33-1.62) for women aged 40-59 years, and 1.29 (1.18-1.41) for women aged 60-79 years.

CONCLUSION

The baseline BMI is associated with future risk for incident hypertension even after accounting for weight change during the follow-up period. Weight loss may be recommended to nonhypertensive obese adults to prevent the development of hypertension.

Differences in weight gain in hypertensive and diabetic elderly patients primary care study

BACKGROUND

Treatment and care of elderly patients with diabetes and hypertension means a hard task in primary care. Patients with these two components of metabolic syndrome are often overweight or obese. Although some parameters of metabolic syndrome are usually measured in a medical setting, checking body weight is usually done by the patients.

AIM

The aim of this study is to analyse the patients' self-recorded data on weight and compare them according to hypertension and diabetes.

PATIENTS AND METHODS

Five hundred and forty people (225 men and 315 women) between 60 and 75 years of age were eventually selected in primary care settings. Retrospective self-recorded data on recent weights and every decade since the age of 20, as well as the decade prior to diagnosis were collected. The data of patients with and without diabetes and/or hypertension were compared.

RESULTS

The current mean body weight was significantly higher in all groups than at the age of 20. Compared with the control group, hypertensive men and women were approximately of the same weight in their twenties and, also, recently, but they gained more weight in the 4th and 5th decades of their life. Diabetics started at higher weights. The greatest weight gain was observed as follows: between 20-30 years and 30-40 years in men and women, respectively, as well as between 50-60 years of age and in the last decade prior to diagnosis in both genders. Weight gain in the control group was steady at a lower rate.

CONCLUSIONS

Weight gain between 20-40 years of age could be an important factor in the aetiology of diabetes. Stable or at least limited weight gain may be a preventive factor. Considering the limitations of the study, further and decades long epidemiological evaluations are suggested in a larger study population.

The association of anthropometric measurements and lipid profiles in Turkish hypertensive adults

BACKGROUND

Few studies have associated anthropometric measurements and lipid profile with hypertension in adult populations and to the best of our knowledge none has been done in Turkey

OBJECTIVES

To relate anthropometric derivatives of overweight/obesity with hyperlipidemia status in a group of Turkish hypertensive adults.

METHODS

Six hundred forty nine (307 male, 342 female) hypertensive adults aged between 20 and 64 years were included in the study.

RESULTS

The mean systolic and diastolic blood pressure (BP) of participants were measured as 147.6 ± 17.2 and 91.4 ± 10.4 mmHg for males and 149.9 ± 16.3 and 91.1 ± 9.4 mmHg for females, respectively. With respect to BMI classification systolic BP was significantly higher in obese males and females, and diastolic BP was only higher in obese females (p<0.05). According to BMIs for lipid profile, high-density lipoprotein-cholesterol (HDL-C), total cholesterol (TC) levels were found to be lower in normal females than other BMI groups. Age and waist circumference (WC) in particular was the most related factor for systolic and diastolic BP in both genders (p<0.05).

CONCLUSIONS

This study indicates most hypertensive adults surveyed were overweight and obese. Furthermore, age and WC were the important factors that affects the systolic and diastolic BP in both genders.

Long-term stable obesity increases risk of hypertension

OBJECTIVES

Although some prospective cohort studies have shown that baseline BMI is positively associated with a future incident risk for hypertension, these studies do not account for weight changes during the observation period. Therefore, it is not evident whether future incident risk for hypertension in obese, non-hypertensive people increases when their weight remains stable. We examined the association between long-term weight stability and risk for developing hypertension.

METHODS

A total of 5201 Japanese male workers aged 30-59 years underwent health checkups in 2002 and were followed through 2006. To consider transitions in covariates during the follow-up period, we used a time-dependent covariate Cox proportional hazard model to compute the relative risks (RRs) of incident hypertension. Furthermore, as a complementary analysis, we restricted the data to individuals whose BMI remained unchanged (± 5% of baseline BMI) during the follow-up and compared the RRs between BMI categories.

RESULTS

During the follow-up, there were 899 newly diagnosed cases of hypertension among the 5201 men (14,888 person-years). Mean change in BMI during the follow-up period of all subjects was 0.2 ± 1.1 kg/m(2) (range: -6.6 to 6.3 kg/m(2)). The multivariate RRs for hypertension increased as BMI increased when we applied the time-dependent covariate Cox proportional hazard model. The complementary analysis showed that the multivariate RR (confidence interval) within the ≥ 27.0 kg/m(2) BMI category was 1.43 (1.16-1.77) times higher than the reference of 23.0-24.9 kg/m(2), whereas the RR for the <21.0 kg/m(2) BMI category was 0.63 (0.51-0.79) times lower than the reference.

CONCLUSIONS

A higher baseline BMI increases future incident risk for hypertension even when there has been no major weight increase. Weight management should be encouraged for obese, non-hypertensive people to prevent future hypertension.

Optimal body weight for the prevention of coronary heart disease in normal-weight physically active men

Although 36% of US men are normal weight (BMI <25 kg/m(2)), the health benefits of greater leanness in normal-weight individuals are seldom acknowledged. To assess the optimal body weight with respect to minimizing coronary heart disease (CHD) risk, we applied Cox proportional hazard analyses of 20,525 nonsmoking, nondiabetic, normal-weight men followed prospectively for 7.7 years, including 20,301 who provided follow-up questionnaires. Two-hundred and forty two men reported coronary artery bypass graph (CABG) or percutaneous transluminal coronary angioplasty (PTCA) and 82 reported physician-diagnosed incident myocardial infarction (267 total). The National Death Index identified 40 additional ischemic heart disease deaths. In these normal-weight men, each kg/m(2) decrement in baseline BMI was associated with 11.2% lower risk for total CHD (P = 0.005), 13.2% lower risk for nonfatal CHD (P = 0.002), 19.0% lower risk for nonfatal myocardial infarction (P = 0.01), and 12.2% lower risk for PTCA or CABG (P = 0.007). Compared to men with BMI between 22.5 and 25 kg/m(2), those <22.5 kg/m(2) had 24.1% lower total CHD risk (P = 0.01), 27.9% lower nonfatal CHD risk (P = 0.01), 37.8% lower nonfatal myocardial infarction risk (P = 0.05), and 27.8% lower PTCA or CABG risk (P = 0.02). In nonabdominally obese men (waist circumference <102 cm), CHD risk declined linearly with declining waist circumference. CHD risk was unrelated to change in waist circumference between 18 years old and baseline except as it contributed to baseline circumference. These results suggest that the optimal BMI for minimizing CHD risk lies somewhere <22.5 kg/m(2), as suggested from our previous analyses of incident diabetes, hypertension, and hypercholesterolemia in these men.