Precursors of essential hypertension. The role of body fat distribution pattern

Translating a health behavior change intervention for delivery to 2-year college students: the importance of formative research

Young adults are at risk for weight gain in the transition to independent adulthood; 2-year college students are at greater risk and understudied relative to 4-year students. This project conducted formative research for a randomized controlled weight gain prevention trial among 2-year college students, to ensure appropriateness of content and delivery of a curriculum originally developed for 4-year college students. Data were collected from community college students, faculty, and staff from October 2009 to August 2011. Work included focus groups and key informant interviews, curriculum pilot testing, and social network and support website beta testing. Based on focus groups and interviews, program content, course delivery modes, and communication channels were adjusted to meet population interests and preferences. The course was delivered successfully in pilot testing, and the website was received well by beta testers. Formative work successfully guided program adaptations to address population needs.

A comparison of the predictive power of anthropometric indices for hypertension and hypotension risk

BACKGROUND AND AIMS

It is commonly accepted that body fat distribution is associated with hypertension, but the strongest anthropometric indicator of the risk of hypertension is still controversial. Furthermore, no studies on the association of hypotension with anthropometric indices have been reported. The objectives of the present study were to determine the best predictors of hypertension and hypotension among various anthropometric indices and to assess the use of combined indices as a method of improving the predictive power in adult Korean women and men.

METHODS

For 12789 subjects 21-85 years of age, we assessed 41 anthropometric indices using statistical analyses and data mining techniques to determine their ability to discriminate between hypertension and normotension as well as between hypotension and normotension. We evaluated the predictive power of combined indices using two machine learning algorithms and two variable subset selection techniques.

RESULTS

The best indicator for predicting hypertension was rib circumference in both women (p = <0.0001; OR = 1.813; AUC = 0.669) and men (p = <0.0001; OR = 1.601; AUC = 0.627); for hypotension, the strongest predictor was chest circumference in women (p = <0.0001; OR = 0.541; AUC = 0.657) and neck circumference in men (p = <0.0001; OR = 0.522; AUC = 0.672). In experiments using combined indices, the areas under the receiver operating characteristic curves (AUC) for the prediction of hypertension risk in women and men were 0.721 and 0.652, respectively, according to the logistic regression with wrapper-based variable selection; for hypotension, the corresponding values were 0.675 in women and 0.737 in men, according to the naïve Bayes with wrapper-based variable selection.

CONCLUSIONS

The best indicators of the risk of hypertension and the risk of hypotension may differ. The use of combined indices seems to slightly improve the predictive power for both hypertension and hypotension.

Diet and lifestyle risk factors associated with incident hypertension in women

CONTEXT

Hypertension is an important preventable risk factor for death among women. While several modifiable risk factors have been identified, their combined risk and distribution in the population have not been assessed.

OBJECTIVE

To estimate the hypothetical fraction of hypertension incidence associated with dietary and lifestyle factors in women.

DESIGN, SETTING, AND PARTICIPANTS

Prospective cohort study of 83,882 adult women aged 27 to 44 years in the second Nurses' Health Study who did not have hypertension, cardiovascular disease, diabetes, or cancer in 1991, and who had normal reported blood pressure (defined as systolic blood pressure of < or = 120 mm Hg and diastolic blood pressure of < or = 80 mm Hg), with follow-up for incident hypertension for 14 years through 2005. Six modifiable lifestyle and dietary factors for hypertension were identified. The 6 low-risk factors for hypertension were a body mass index (BMI) of less than 25, a daily mean of 30 minutes of vigorous exercise, a high score on the Dietary Approaches to Stop Hypertension (DASH) diet based on responses to a food frequency questionnaire, modest alcohol intake up to 10 g/d, use of nonnarcotic analgesics less than once per week, and intake of 400 microg/d or more of supplemental folic acid. The association between combinations of 3 (normal BMI, daily vigorous exercise, and DASH-style diet), 4 (3 low-risk factors plus modest alcohol intake), 5 (4 low-risk factors plus avoidance of nonnarcotic analgesics), and 6 (folic acid supplementation > or = 400 microg/d) low-risk factors and the risk of developing hypertension was analyzed.

MAIN OUTCOME MEASURES

Adjusted hazard ratios for incident self-reported hypertension and population attributable risks (PARs).

RESULTS

A total of 12,319 incident cases of hypertension were reported. All 6 modifiable risk factors were independently associated with the risk of developing hypertension during follow-up after also adjusting for age, race, family history of hypertension, smoking status, and use of oral contraceptives. For women who had all 6 low-risk factors (0.3% of the population), the hazard ratio for incident hypertension was 0.22 (95% confidence interval [CI], 0.10-0.51); the hypothetical PAR was 78% (95% CI, 49%-90%) for women who lacked these low-risk factors. The corresponding hypothetical absolute incidence rate difference (ARD) was 8.37 cases per 1000 person-years. The PARs were 72% (95% CI, 57%-82%; ARD, 7.76 cases per 1000 person-years) for 5 low-risk factors (0.8% of the population), 58% (95% CI, 46%-67%; ARD, 6.28 cases per 1000 person-years) for 4 low-risk factors (1.6% of the population), and 53% (95% CI, 45%-60%; ARD, 6.02 cases per 1000 person-years) for 3 low-risk factors (3.1% of the population). Body mass index alone was the most powerful predictor of hypertension, with a BMI of 25 or greater having an adjusted PAR of 40% (95% CI, 38%-41%) compared with a BMI of less than 25.

CONCLUSIONS

Adherence to low-risk dietary and lifestyle factors was associated with a significantly lower incidence of self-reported hypertension. Adopting low-risk dietary and lifestyle factors has the potential to prevent a large proportion of new-onset hypertension occurring among young women.

Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study

OBJECTIVE

To evaluate any association between obesity in middle age, measured by body mass index and skinfold thickness, and risk of dementia later in life.

DESIGN

Analysis of prospective data from a multiethnic population based cohort.

SETTING

Kaiser Permanente Northern California Medical Group, a healthcare delivery organisation.

PARTICIPANTS

10,276 men and women who underwent detailed health evaluations from 1964 to 1973 when they were aged 40-45 and who were still members of the health plan in 1994.

MAIN OUTCOME MEASURES

Diagnosis of dementia from January 1994 to April 2003. Time to diagnosis was analysed with Cox proportional hazard models adjusted for age, sex, race, education, smoking, alcohol use, marital status, diabetes, hypertension, hyperlipidaemia, stroke, and ischaemic heart disease.

RESULTS

Dementia was diagnosed in 713 (6.9%) participants. Obese people (body mass index > or = 30) had a 74% increased risk of dementia (hazard ratio 1.74, 95% confidence interval 1.34 to 2.26), while overweight people (body mass index 25.0-29.9) had a 35% greater risk of dementia (1.35, 1.14 to 1.60) compared with those of normal weight (body mass index 18.6-24.9). Compared with those in the lowest fifth, men and women in the highest fifth of the distribution of subscapular or tricep skinfold thickness had a 72% and 59% greater risk of dementia, respectively (1.72, 1.36 to 2.18, and 1.59, 1.24 to 2.04).

CONCLUSIONS

Obesity in middle age increases the risk of future dementia independently of comorbid conditions.

Is central obesity associated with cirrhosis-related death or hospitalization? A population-based, cohort study

BACKGROUND & AIMS

We aimed to determine the interaction between body fat distribution (central versus peripheral) and increased body mass index (BMI) with regards to the risk of cirrhosis-related death or hospitalization.

METHODS

Participants included 11,434 persons aged 25-74 years without evidence of cirrhosis at entry into the study or during the first 5 years of follow-up who were subsequently followed for a mean of 12.9 years as part of the first National Health and Nutrition Examination Survey. Participants were categorized into "normal-weight" (BMI < 25 kg/m 2 , N = 5750), "overweight" (BMI 25 to < 30 kg/m 2 , N = 3770), and "obese" (BMI > or = 30 kg/m 2 , N = 1914). The subscapular to triceps skinfold thickness ratio (SFR) was used to categorize body fat distribution into central (SFR > 1, N = 5211) and peripheral (SFR < or = 1, N = 6223).

RESULTS

Cirrhosis resulted in death or hospitalization of 88 participants during 149,888 person-years of follow-up (59/100,000 person-years). Among persons with a central body fat distribution, cirrhosis-related deaths or hospitalizations were more common in obese persons (115/100,000 person-years, adjusted hazard ratio 2.2, 95% confidence interval [CI] 1.1-4.6) and in overweight persons (94/100,000 person-years, adjusted hazard ratio 1.5, 95% CI 0.8-3.0) compared to normal-weight persons (59/100,000 person-years). However, among persons with a peripheral fat distribution, there was no association between obesity (adjusted hazard ratio 0.7, 95% CI 0.3-1.6) or overweight (adjusted hazard ratio 0.8, 95% CI 0.2-2.8) and cirrhosis-related death or hospitalization.

CONCLUSIONS

The risk of cirrhosis-related death or hospitalization appears to be increased in the presence of cirrhosis, but only among persons with a central fat distribution. The excess risk associated with central obesity might be related to insulin resistance and hepatic steatosis.

Body mass index in primary and secondary pediatric hypertension

The objectives of this study were (1) to determine the relationship of body mass index (BMI) to primary or secondary hypertension in children and adolescents and (2) to assess BMI at the age of onset of hypertension in children and adolescents. Patient demographics, BMI, family history, presentation of disease, etiology of hypertension, medication, laboratory data, and findings from other procedures were recorded for all patients with hypertension followed in the Pediatric Nephrology Clinic at Children's Hospital, Columbus, Ohio, over a 4-year period. In total, 314 patients were studied: 218 with primary hypertension and 96 with secondary hypertension. Our patient population (166 males, 148 females) was diverse in age (13+/-6.3 years) and ethnicity (237 Caucasians, 54 African-Americans, 23 other). BMI was greater in patients with primary (27.5+/-9.2 kg/m2) versus secondary (23.9+/-9.3 kg/m2) hypertension (P=0.002). Children with primary hypertension with an increased BMI presented at an earlier age than children with secondary hypertension and an increased BMI. The age of onset (10.5+/-2.6 years) in primary hypertension was related to increased BMI (r=0.12, P=0.001); however, there was no relationship between BMI and age of onset of secondary hypertension (P=0.21). Children whose family members had essential hypertension had increased BMI compared with children without a family history of essential hypertension. Based on the logistic regression model constructed from our data, the likelihood of primary versus secondary hypertension was influenced by the presence of family history of hypertension independent of presence of obesity in the child. In conclusion, increased BMI is more common in children with primary than secondary hypertension; earlier onset of primary hypertension in the pediatric population was associated with increased BMI; the assessment of BMI is important in the evaluation of secondary as well as primary hypertension; the role of obesity in the development of secondary as well as primary hypertension in children merits further study.

Reduction of risk factors for cardiovascular diseases in morbid-obese patients following biliary-intestinal bypass: 3 years' follow-up

BACKGROUND

Obese patients are often affected by hypertension, dyslipidaemia, impaired glucose metabolism, and suffer from cardiovascular disease (CVD), related to the characteristic metabolic alterations.

AIM OF THE STUDY

To evaluate reduction of risk factors for CVDs in morbid-obese patients (body mass index (BMI)>40 kg/m2) after weight loss upon bariatric surgery intervention of biliary-intestinal bypass.

SUBJECTS

45 (17 men, 28 women) morbid-obese patients (age: 19-49 y, BMI>40 kg/m2). All patients were selected on the basis of medical history, physical and biochemical evaluation and of psychiatric tests, which were performed on all individuals admitted to our Day Hospital to verify the safety of surgical intervention.

MEASUREMENTS

Body weight, body composition (by dual X-ray absorptiometry, DXA), blood pressure, lipid profile, fibrinogen and glucose metabolism were monitored at baseline and 1, 3, 6, 9, 12, 24 and 36 months after surgery.

RESULTS

A significant and persistent weight loss was present in all patients at the end of the 3 y follow-up period (P<0.001), with a progressive reduction of total and trunk fat mass as evaluated by means of DXA. Additionally, a parallel significant reduction in systolic (P<0.001) and diastolic (P<0.001) blood pressure was observed. Total and LDL cholesterol were significantly reduced (P<0.001), while HDL showed no modifications; triglycerides declined progressively during the 3 y follow-up (P<0.001). Fibrinogen decreased from 364.5+/-82.4 to 266.4+/-45.7 mg/dl at the end of the period (P<0.001). Fasting glucose levels and glucose levels 120 min after an oral glucose tolerance test were reduced from 95.1+/-20.3 to 78.6+/-9.1 mg/dl (P<0.001) and from 116.9+/-34.7 to 77.6+/-15.5 mg/dl (P<0.001), respectively, at baseline and at the end of the study. Moreover, fasting insulin decreased from 30.0+/-20.4 to 8.6+/-2.9 microUI/ml (P<0.001) after 3 y, while insulin levels after (120 min) oral glucose load decreased from 105.5+/-61.5 to 12.0+/-6.0 microUI/ml (P<0.001).

CONCLUSION

Our results show that biliary-intestinal bypass may represent a valid and alternative therapeutic approach in patients with morbid obesity since it induces a significant and stable reduction of body weight and obesity-related risk factors for CVD.

Clinical features of the metabolic syndrome in adolescents: minor role of the Trp64Arg beta3-adrenergic receptor gene variant

Obesity and hypertension are increasing medical problems in adolescents. We evaluated the association between being overweight-particularly abdominal fat-and having hypertension and assessed the contribution of the Trp64Arg beta3-adrenergic receptor gene variant. In a population-based study, we determined family history, anthropometric variables, and arterial blood pressure of 934 high school students, out of whom we selected 121 normotensive and 54 hypertensive students. Biochemical measurements included circulating renin and angiotensin-converting enzyme activities, leptin, glucose, insulin and lipid levels, and beta3-adrenergic receptor genotypes. We used Mann-Whitney U test, chi2-test, and Spearman rank-order correlation. In the total population, hypertension prevalence increased across the entire range of body mass index (BMI) percentiles. In the sample, hypertensive students showed higher BMI, waist-to-hip ratio, triglycerides, and insulin resistance and lower HDL-cholesterol than normotensive students did. Age- and sex-adjusted systolic arterial blood pressure was correlated with BMI, waist-to-hip ratio, insulin resistance, and leptin. Leptin was correlated with BMI and homeostasis model assessment method. We found no association among hypertension, BMI, and leptin levels with beta3-adrenergic receptor genotypes. Especially in girls, the waist-to-hip ratio was, however, suggestively higher in Arg64 variant carriers than in noncarriers, independent of hypertension. In fact, there was a significantly (p < 0.01) higher frequency of carriers of the Arg64 variant across the waist-to-hip ratio quartiles. In adolescents of European origin, hypertension is associated with an increased degree of obesity among other characteristics of the metabolic syndrome; the Trp64Arg variant of the beta3-adrenergic receptor gene may favor the central adiposity gain.

Alcohol reduces insulin-hypertension relationship in a general population: the Hisayama study

Insulin resistance may be a factor in the etiology of hypertension, and habitual alcohol intake may modify this relationship. We prospectively examined this hypothesis in 1,133 nonhypertensive, nondiabetic Japanese subjects, aged 40-79 years. Alcohol drinkers were more frequent among men than women at baseline (57.7 vs. 8.2%). The age-adjusted incidence of hypertension significantly increased with the elevating baseline insulin levels in women (P =.003 for trend), but not in men. The age- and sex-adjusted insulin levels and insulin resistance index decreased with elevating alcohol intake, while fasting glucose levels remained unchanged, suggesting that alcohol improves insulin sensitivity. Among nondrinkers, the age-adjusted incidence of hypertension significantly increased with elevating insulin tertiles in both sexes (P =.048 and.002 for trend in men and women, respectively), but not among drinkers. Our findings suggest a close association between insulin resistance and the incidence of hypertension in Japanese. However, alcohol modified and reduced this relationship.

Associação do índice de massa corporal e da relação cintura/quadril com hospitalizações em adultos do Município do Rio de Janeiro, RJ

O índice de massa corporal tem sido associado à morbidade e à mortalidade. Câncer, doenças infecciosas e pulmonares têm sido associadas ao baixo peso; entretanto, qualquer grau de excesso de peso e também a deposição de gordura abdominal associam-se a diabetes e doenças cardiovasculares. A associação do índice de massa corporal e da razão cintura quadril com a ocorrência de hospitalizações foram avaliadas em uma amostra de base populacional no Município do Rio de Janeiro (1996). Moradores de ambos os sexos, de 20 a 60 anos, totalizando 1.446 homens e 1.749 mulheres foram medidos e entrevistados em seus próprios domicílios. A hospitalização referiu-se à presença ou não de internações no último ano, excluindo-se partos. Cerca de 5% dos homens e 5,8% das mulheres relataram ter sido internados. Para as mulheres, a prevalência de hospitalizações aumentou gradativamente com o aumento do índice de massa corporal. O método de regressão logística foi escolhido para a análise, tendo a hospitalização como variável dependente e incluindo no modelo a idade, tabagismo, renda per capita, índice de massa corporal e razão cintura quadril. Estes dois últimos associaram-se positivamente com as hospitalizações somente para mulheres (Odds ratio=1,06 para cada unidade de índice de massa corporal, p=0,01), e em relação à gordura abdominal, um aumento de 12 cm na cintura de uma mulher com 80 cm de quadril resultou num Odds ratio de 3,5 (p=0,01). O excesso de peso e, particularmente, a deposição abdominal de gordura são importantes preditores de morbidade em mulheres, avaliadas através das hospitalizações.

The American Heart Association Dietary Guidelines for 2000: a summary report

Recently, the American Heart Association published a revision of its dietary guidelines. The recommendations are based on new scientific findings, and address the contribution of growing rates of obesity, hypertension, and diabetes to heart disease in the United States. The guidelines for the general public are similar to dietary recommendations made by other health-related groups and government agencies and, therefore, place a greater emphasis on the adoption of healthy eating patterns and behaviors rather than a singular focus on dietary fat intake.

Heritability estimates of obesity measures in siblings with and without hypertension

The goal of the present study was to evaluate mean values and heritability estimates of 3 global and 11 regional obesity measures in siblings with (HPT, n=209) or without (non-HPT, n=91) early-onset (age </=55 years) hypertension who originated from the same families. Sixty-one sibships, each having at least 2 HPT siblings, were selected from a French-Canadian population with a known founder effect. Comparison of the mean values showed that HPT siblings are more obese than non-HPT siblings and that the body fat of HPT siblings is more centrally distributed. Significant differences were observed in all global obesity measures (P=0.009 to 0.0001). Among the regional measures, the most prominent differences were seen in waist circumference (P=0.00002), waist/hip ratio (P=0.0001), and suprailiac skinfold (P=0.00008). Comparison of the heritability estimates derived from sibling/sibling correlations (FCOR program, SAGE) suggested that genetic factors play a greater role in HPT (n=357) than in non-HPT (n=93) sib-pairs in determining most obesity measures. Similar to the mean values, these differences were most apparent in global and upper-body measures, with heritabilities ranging from 40% to 70% (P=0.05 to 0.0006) in HPT siblings and from 0% to 32% (P=NS) in non-HPT siblings. In summary, the present results suggest that HPT and non-HPT siblings drawn from the same families differ by the degree and distribution of body fat accumulation and that this difference is determined, at least in part, by genetic factors cosegregating with hypertension. This, in turn, suggests that a genetic link exists between obesity and hypertension in these families.

The Trp64Arg polymorphism of the beta3-adrenergic receptor gene is associated with hypertension in men with type 2 diabetes mellitus

A missense mutation of the beta3-adrenergic receptor gene (ADRB3) resulting in a tryptophan/arginine exchange at position 64 (Trp64Arg polymorphism) has recently been associated with greater capacity to gain weight, a low resting metabolic rate, higher blood pressure, and an early onset of type 2 diabetes. These findings prompted us to examine the relationship between this mutation, blood pressure, and vascular complications in German patients with type 2 diabetes. White patients with type 2 diabetes mellitus (n = 417) were enrolled in the study. The Trp64Arg polymorphism of the ADRB3 gene was detected by polymerase chain amplification and subsequent restriction digest with BstN I. Stepwise logistic regression analysis of the entire study population revealed a significant interaction between gender and genotype (P = .019). We therefore performed separate analyses for men and women. There was a significant relationship between hypertension and the ADRB3 Trp64Arg variant in men (P = .015), but not in women. Furthermore, blood pressure levels in male patients with the minor allele had higher blood pressure levels (P < .05), despite a significantly greater number of antihypertensive medications (P = .01). There was no association between ADRB3 genotype and vascular complications in these patients. In conclusion, our data are compatible with a contribution of this genetic variant of ADRB3 to hypertension in male patients with type 2 diabetes. Further studies will be needed to determine the role of this polymorphism as a predictor of hypertension or vascular complications in patients with type 2 diabetes.

Obesity, body fat distribution, and coronary artery disease

Obesity is an independent risk factor for the development of coronary artery disease (CAD). Obesity also increases risk for CAD indirectly through its association with insulin resistance, hyperlipidemia, and hypertension. An increased accumulation of fat in the intraabdominal cavity, termed visceral adiposity, is highly correlated with an adverse coronary risk profile. In patients at risk for coronary artery disease, the treatment of obesity results in an improved coronary risk profile. The prevalence of obesity is extremely high in coronary populations, yet the effect of weight loss on cardiovascular outcomes in CAD patients has received relatively little attention. Observational studies in the cardiac rehabilitation setting showed that patients who lose weight and exercise show an improvement in coronary risk profile. Further research is needed to better define the clinical effectiveness of weight loss programs and their benefits in coronary patients.

Norepinephrine kinetics in older women: relationship to physical activity and blood pressure

The sympathetic nervous system participates in the regulation of carbohydrate, lipid, and energy metabolism, and has been implicated in the pathogenesis of hypertension and obesity. Increased sympathetic nervous system activity with age may alter disease risk and contribute to the development of certain chronic diseases. Thus, we examined possible determinants of sympathetic nervous system activity in older normotensive women from infusions of tritiated norepinephrine (NE) to estimate rates of norepinephrine appearance and clearance. A secondary aim was to examine the association between norepinephrine kinetics and mean supine arterial blood pressure. Twenty-two older women (65.7 +/- 5.7 years) were characterized for resting NE kinetics, body composition, body fat distribution, peak aerobic capacity, leisure time physical activity energy expenditure (LTA), dietary carbohydrates, and daily energy intake. Analysis of univariate correlations revealed that only the LTA was significantly correlated with plasma NE appearance (r = 0.54, p < 0.01). Stepwise regression analysis identified LTA as the only significant predictor of plasma NE appearance rate with a total R2 = 0.29. The waist-to-hip ratio was selected as the only significant predictor of mean arterial blood pressure with an R2 = 0.30. When forced into the model, plasma NE appearance explained only 1% of the unique variance in mean arterial blood pressure. In summary, we found that: (1) higher levels of physical activity are related to higher plasma NE appearance in older women; (2) greater central body fatness is an independent predictor of mean arterial blood pressure; and (3) plasma NE appearance rate is a minor contributor to variation in mean arterial blood pressure in older, normotensive women.

Risk factors for the development of hypertension: a 6-year longitudinal study of middle-aged Japanese men

OBJECTIVE

To identify the factors related to the development of hypertension on the basis of annual health examinations at the workplace.

SETTING

A cohort of Japanese male office workers who were reexamined for six successive years after their initial examinations in 1990.

SUBJECTS

The study cohort comprised 1089 hypertension-free subjects aged 30-54 years. Six-year follow-ups were completed for 934 subjects (85.8%)

RESULTS

An analysis using the Kaplan-Meier method showed that the incidence of hypertension above the borderline level increased significantly with increasing age, body mass index, systolic blood pressure, diastolic blood pressure, total cholesterol level, uric acid level, total protein level, hematocrit level, and alcohol intake. This increase was significant for systolic blood pressure, diastolic blood pressure, and hematocrit level. The highest cumulative incidences both of hypertension above the borderline level and of definite hypertension were observed among those with 85-89 mmHg diastolic blood pressure, and the second highest among those with 130-139 mmHg systolic blood pressure. Multivariate analysis using the Cox proportional hazards model indicated that age, systolic blood pressure, diastolic blood pressure, and alcohol intake were independent factors associated with the incidence of hypertension above the borderline level. Systolic blood pressure, diastolic blood pressure, and hematocrit level proved to be independently predictive of hypertension, and alcohol intake was of borderline significance as a risk factor for hypertension.

CONCLUSION

High normal blood pressure is the strongest predictor for the development of hypertension among middle-aged Japanese men. In addition, high alcohol intake and high hematocrit level may be contributory factors.

Influence of physiological factors on the age-related increase in blood pressure in healthy men

The independent and collective influences of several physiological factors on the age-related increase in blood pressure in healthy men were examined. Twenty-seven younger and 25 older, mostly normotensive, healthy men were studied. Blood pressure, body fat, body fat distribution, maximal oxygen consumption (VO2max), plasma norepinephrine, dietary Na, and erythrocyte Na-K pump activity were measured. Older men showed 57% higher percent body fat, 40% higher plasma norepinephrine concentration, 14% greater mean arterial blood pressure (MAP), and 5% higher plasma K concentration than younger men (all p < 0.01). Older men showed a 38% (p < 0.01) lower VO2max, 19% (p < 0.05) lower energy intake, 18% (p < 0.05) lower Na-K pump rate constant, and a 17% (p < 0.05) lower Na-K pump rate. Group means for MAP were adjusted for combinations of plasma norepinephrine, waist:thigh ratio, VO2max, and the Na-K pump rate constant, to determine if any one variable or combination could account for the age related increase in MAP. Statistical adjustment for plasma norepinephrine, waist:thigh ratio, and Na-K pump rate constant eliminated the significant difference between MAPs for the two groups. Thus, alterations in sympathetic nervous system activity, body fat distribution, and the membrane Na-K pump activity independently contribute to the age-related increase in MAP in healthy men.

Ten-year changes in the obesity, abdominal adiposity, and serum lipoprotein cholesterol measures of Western Samoan men

Previously reported associations between abdominal adiposity and coronary heart disease (CHD) may be mediated through serum lipids. In the present longitudinal study, 43 Western Samoan men who participated in a 1982 study were recontacted for a second determination of anthropometric and serum lipoprotein cholesterol levels. The men showed dramatic increases in weight (mean change +/- SD: 10.5 +/- 8.8 kg), abdominal circumference (10.0 +/- 7.6 cm), total cholesterol (49.5 +/- 26.4 mg/dl), and non-HDL cholesterol (53.1 +/- 26.6 mg/dl). A new indicator was used to estimate changes in abdominal adiposity: the residual from the regression of change in the abdominal circumference on change in body weight (the AR). The AR was significantly correlated with changes in total (r = 0.38) and non-HDL cholesterol (r = 0.39). Changes in HDL cholesterol were correlated with changes in weight only (r = -0.37). These bivariate relations remained significant in multiple linear regression analyses. These longitudinal results are the first to suggest changes in abdominal adiposity are related to changes in total and non-HDL cholesterol levels.

Glucose metabolism in abdominally obese hypertensive and normotensive subjects

To determine whether the combination of obesity and hypertension results in additive defects in oxidative and nonoxidative glucose metabolism and the association of these changes with altered hemodynamic actions of insulin, we studied 11 abdominally obese hypertensive, 6 abdominally obese normotensive, and 7 lean normotensive nondiabetic subjects. Endogenous glucose production and glucose metabolized were calculated from a euglycemic clamp at 72 and 287 pmol insulin/m2 per minute. Glucose metabolized divided by insulin was lower at 72 pmol/m2 per minute in both obese groups than in lean normotensive subjects, at 148 +/- 14, 144 +/- 33, and 373 +/- 69 (mumol/m2 per minute)/(pmol/L), respectively (P < .01). Similar results were obtained during the higher insulin dose. Nonoxidative and oxidative glucose disposals by indirect calorimetry were lower in both abdominally obese groups (P < .05). Hepatic glucose production was completely suppressed in lean subjects at the lower insulin dose and in all three groups at the higher insulin dose. Hemodynamic responses during the clamp were not significantly different among the three groups. Abdominal obesity is associated with defects in insulin-regulated oxidative and nonoxidative glucose disposal as well as in insulin suppression of hepatic glucose production. Mild hypertension does not exacerbate these defects. Whereas the global impairment in glucose metabolism suggests the presence of an early defect or defects, including reduced tissue perfusion, systemic and regional hemodynamic responses to insulin were not altered. These findings do not support a direct role for insulin resistance in the pathogenesis of the hypertension associated with abdominal obesity.

Prevalence of hypertension in Mexico City and San Antonio, Texas

BACKGROUND

Few data are available on the prevalence of hypertension in Mexico.

METHODS AND RESULTS

We compared the prevalence of mild hypertension (systolic blood pressure > or = 140 mm Hg and/or diastolic blood pressure > or = 90 mm Hg and/or use of antihypertensive medications) in 1500 low-income Mexican Americans who participated in the San Antonio Heart Study and 2280 low-income Mexicans who participated in the Mexico City Diabetes Study. The crude prevalence of mild hypertension was 17.1% in Mexican men versus 24.4% in Mexican American men (P = .001) and 17.4% in Mexican women versus 22.0% in Mexican American women (P = .005). After adjustment for age, body mass index (BMI), waist-to-hip ratio (WHR), non-insulin dependent diabetes mellitus (NIDDM), educational attainment, and percent native American genetic admixture (Caucasian and native American), the odds ratio (Mexico City/San Antonio) was 0.55 (95% CI, 0.39, 0.77; P < .001) in men and 0.81 (CI, 0.54, 1.12; P = .201) in women. In a pooled model including both men and women, the odds ratio was 0.67 (95%, CI, 0.53, 0.84; P < .001). In the pooled model, city, age, female sex, NIDDM, BMI, WHR, and low educational attainment were significantly related to the prevalence of hypertension.

CONCLUSIONS

The causes for these differences in hypertension prevalence are not known but may reflect a less modernized lifestyle in Mexico City, including greater physical activity, less obesity, and the consumption of a high-carbohydrate, low-fat diet.

The epidemiology of obesity

Obesity and pattern of fat distribution are both important factors related to poor health outcomes. Many measures of obesity and fat distribution pattern have been employed by different authors and to facilitate interpopulation comparisons and interpretation of secular trends it is necessary that standardized methods for measurement and classification are set in place. The use of BMI as a measure of fatness for epidemiological studies is widely accepted, easily measured and BMI predicts morbidity and mortality in many populations. The most appropriate level at which to define obesity is a matter of debate but systems which use BMI > or = 25 and < or = 30 kg/m2 as overweight, and BMI > 30 kg/m2 as obese for all adults are simple, easily remembered, already widely used and BMIs above 30 kg/m2 are clearly associated with increased risk of morbidity and mortality. In some populations there may be a case for using a lower cut-off but not unless there is specific evidence to support this. For the present WHR is probably the best method for assessing fat distribution, although waist circumference on its own may be more useful in determining risk levels. Standard sites for measurement of both waist and hip girths have been described. There is a large variation in the prevalence of obesity across the populations for which data is available, with high prevalences of obesity and dramatic secular trends especially apparent in modernizing Pacific Island populations. The 'thrifty genotype' hypothesis has been invoked to try and explain this situation. The clustering of obesity, NIDDM and CVD risk factors has been recognized and various 'syndromes' have been described which group different factors together, with hyperinsulinaemia and insulin resistance proposed as the underlying problem.

Increased body weight in men after the age of 55 is a risk factor for internal carotid artery stenosis: an epidemiological study of men aged 69

A population-based cohort of 393 men born in 1914 and residing in the city of Malmö, Sweden, was examined at ages 55 and 69 years, respectively, with regard to risk factors for arteriosclerotic vascular and coronary disease. At age 69 an examination of the carotid arteries with Doppler ultrasound was carried out also, to establish the prevalence and degree of stenosis in the carotid vessels. The material was analysed for the following risk factors for internal carotid artery stenosis: systolic and diastolic blood pressure, cholesterol, triglycerides, haematocrit, gamma glutamyl transferase (GT), blood glucose, body mass index (BMI), body weight change (BWC), and smoking. Stepwise multiple regression analysis showed that only increased body weight between 55 and 69 years of age and the earlier known risk factor, smoking, remained as independent risk factors for developing carotid artery disease.

Body fat distribution in men and women of the Hispanic health and nutrition examination survey of the United States: associations with behavioural variables

Body fat distribution is a biological risk factor for cardiovascular disease and diabetes. There are known genetic factors influencing body fat distribution, but variation in this characteristic is also attributable to human behavioural and socioeconomic variables such as social class. Björntorp has proposed that these associations may be due to a series of physiological responses to psychosocial stress, most prominently chronic stimulation of the adrenal-cortical system. This system is known to affect body fat distribution. Elsewhere we have shown that general socioeconomic status is related to body fat distribution in men and women of the Hispanic Health and Nutrition Examination Survey (HHANES) of the United States. In this paper we explore the relationship with those behavioural variables available from the HHANES which could hypothetically serve as indicators of psychosocial stress: smoking, drinking and depression. For both sexes in all Hispanic ethnic groups except Puerto Rican men, as socioeconomic status declined, subcutaneous fat became more centrally distributed. This relationship continued to be significant after controlling for the behavioural variables. A positive relationship was also found between smoking and central body fat distribution which was independent of socioeconomic status. This relationship was statistically significant for all subsamples except Cuban-American women. No consistent relationships were found between body fat distribution, drinking and depression. The data support the hypothesis that body fat distribution may be linked to the social stress of low socioeconomic status, independent of the behavioural factors tested.

Higher serum insulin level due to greater total body fat mass in offspring of patients with essential hypertension

To determine whether the offspring of hypertensive patients (OHP) might have a higher serum insulin level than offspring of normotensive parents, we studied 152 girls in junior high school, 21 of whom had at least one hypertensive parent. The remaining 131 girls had normotensive parents and served as the controls. After an overnight fast, we measured the subjects' height, body weight, blood pressure and body fat mass, and collected blood for assay of serum immunoreactive insulin (IRI), lipids and apolipoproteins. Despite a similar body mass index, the OHP had a significantly greater body fat mass (P < 0.05) and % fat mass (P < 0.05) than the controls. The OHP exhibited a significantly higher serum IRI level than the controls (P < 0.05), but no differences in blood pressure or serum lipids. In the OHP, % body fat mass was significantly correlated with systolic blood pressure (P < 0.05), triglyceride (P < 0.01) and apolipoprotein B (P < 0.01), not observed in controls. The serum IRI of the OHP, but not that of controls, was significantly correlated with systolic blood pressure (P < 0.05), serum triglyceride (P < 0.02) and apolipoprotein B (P < 0.05). Thus, a higher serum IRI level due to an increase in total body fat mass appears to be an inherited trait that contributes to the development of hypertension and dyslipidemia.

Subscapular and triceps skinfold thicknesses, body mass index and cardiovascular risk factors in a cohort of middle-aged employed men

Associations of indices of adiposity with cardiovascular risk factors were examined in 1860 middle aged men employed by the Western Electric Company in Chicago in 1960 and 1961. Body mass index and subscapular and triceps skinfolds were examined for associations with systolic and diastolic blood pressure, serum cholesterol, and post-load serum glucose. Correlations of study variables measured one year apart suggest that triceps and subscapular skinfold measurements are less reproducible than body mass index, but more reproducible than measurements of systolic and diastolic blood pressure and serum cholesterol. Associations with blood pressure were stronger for body mass index than for skinfolds, and subscapular skinfold was associated with blood pressure independently of triceps skinfold, as well as age, heart rate, alcohol intake, and family history of cardiovascular disease. Body mass index was also generally more strongly related to serum cholesterol than skinfold measurements. Triceps skinfold was more strongly related to serum cholesterol than subscapular skinfold based on average values for the variables in 1960-61, but subscapular skinfold was more strongly related to one-year change in serum cholesterol. Subscapular skinfold was as strongly related to serum glucose as body mass index. This association was also independent of triceps skinfold and other variables. These analyses demonstrate positive associations of subscapular skinfold, an index of central adiposity, with blood pressure and serum glucose levels. Associations of subscapular and triceps skinfolds with serum cholesterol levels were not consistent in the cross-sectional and longitudinal analyses and require further investigation.

Level of control of hypertension in Mexican Americans and non-Hispanic whites

Compared with non-Hispanic whites, Mexican Americans have a higher prevalence of diabetes, greater adiposity, and an unfavorable body fat distribution. The prevalence of hypertension, however, is similar or lower in Mexican Americans than in non-Hispanic whites. There is little information on the level of blood pressure control in Mexican Americans. We compared the mean blood pressure levels of Mexican American and non-Hispanic white hypertensive subjects in the San Antonio Heart Study, a population-based study of diabetes and cardiovascular disease. Hypertension was defined as one or more of a systolic blood pressure > or = 160 mm Hg, a diastolic blood pressure > or = 95 mm Hg, and current use of antihypertensive medications. Three hundred and fifty-eight Mexican Americans and 241 non-Hispanic whites met these criteria. Poor hypertension control was defined as a systolic blood pressure > or = 160, a diastolic blood pressure > or = 95 mm Hg, or both. After adjustment for age, gender, obesity, body fat distribution, and level of educational attainment, Mexican American hypertensive subjects were in significantly poorer control than non-Hispanic white hypertensive subjects. The reasons for their poorer control are unknown, but our findings emphasize the importance of hypertension in this ethnic group.

Challenging commonly held beliefs about obesity

The task of nurses is to diagnose and treat human responses to illness and the threats of illness. The challenge is in finding the correct diagnosis and selecting the appropriate treatment. To do this appropriately, nurses need to separate health and illness from life-style; to discover whether or not life-style changes are really called for in treating illness or threats of illness or if nurses are uncomfortable with life-styles that are different from their own and expect all people to have a life-style similar to theirs. To intervene appropriately, nurses need to know whether they are working to help others return to their life-style preference or are forcing patients to chose the nurses' life-style preference. The case of the obese and the search for the successful dieter exemplifies the health care system's need to have individuals follow an exercise and eating program to lead them to thinness (a cultural value) whether or not they value thinness. Are health professionals forcing patients to conform to the professionals' life-style rather than assisting them to a healthier state within their own?

Body fat distribution and job stress in Mexican-American men of the hispanic health and nutrition examination survey

A positive relationship between psychosocial stress and central body fat distribution has been hypothesized. To test this hypothesis, two indices derived from principal components analysis of four skinfold measurements were studied in relation to imputed job stress characteristics (decision latitude, skill discretion, decision authority, and psychological demands) in Mexican-American men of the U.S. Hispanic Health and Nutrition Examination Survey (HHANES). The two indices were fatness and central body fat distribution. Fatness was not significantly associated with any of the job stress characteristics before controlling for education. Once education was included in the equations, however, the relationship between fatness and two of the four job stress variables (decision authority and psychological demands) became statistically significant. Thus, for a given level of education, increasing job stress was associated with increasing fatness. Three of the four job stress characteristics were significantly associated with central body fat distribution before controlling for education. However, after education was entered into the regression equations as a proxy for social class, the relationships between central body fat distribution and the job stress variables were no longer significant. It thus appears that aspects of social class other than job stress are of equal or greater importance in predicting body fat distribution. © 1992 Wiley-Liss, Inc.

Predictors of an increased risk of future hypertension in Utah. A screening analysis

A prospective study on 1,482 adult members of 98 Utah pedigrees was carried out to determine which variables may be associated with an increased risk of hypertension incidence. After an average of 7 years of follow-up, 40 individuals had been placed on antihypertensive medications to lower blood pressure. Baseline study variables included anthropometrics, clinical chemistry measurements of blood and urine, socioeconomic and lifestyle variables, and detailed erythrocyte ion transport and concentration measurements. Age (relative risk of 4.28 for a 2 SD difference, p less than 0.0001) and baseline systolic and diastolic blood pressures (relative risks of 3.55 and 3.52, respectively, both p less than 0.0001) had the strongest associations with hypertension incidence. Controlling for age and baseline blood pressure, the following age- and sex-adjusted variables were associated with an increased risk of future hypertension (relative risks for a 2 SD difference, all p less than 0.10): family history of hypertension (2.35); height (1.97); body mass index (2.31); abdominal girth (2.66); subscapular, suprailiac, and triceps skinfold thicknesses (2.79, 2.52, and 2.28, respectively); percent ideal body weight (2.63); log triglyceride concentration (2.02); plasma uric acid (2.16); inorganic phosphate (0.50); and passive erythrocyte sodium permeability (1.59). The final model,which included all of the age- and sex-adjusted variables (p less than 0.10) in a backward elimination logistic regression analysis, consisted of age (4.78), systolic blood pressure (2.91), subscapular skinfold thickness (2.21), height (1.92), uric acid (2.06), inorganic phosphate (0.50), and family history of hypertension (1.82). None of the ion transport or concentration measurements ws associated with an increased risk of hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels

STUDY OBJECTIVE

The aim was to examine (1) whether health habits are associated with body fat distribution, as measured by the waist/hip girth ratio, and (2) to what extent environmental factors, including anthropometric characteristics, explain the variability in levels of cardiovascular risk factors.

DESIGN

The study was a population based cross sectional survey, conducted in the spring of 1987 as a part of an international research project on cardiovascular epidemiology.

SETTING

The survey was conducted in three geographical areas of eastern and south western Finland.

SUBJECTS

2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%.

MEASUREMENTS AND MAIN RESULTS

In men, waist/hip ratio showed stronger associations with exercise (Pearson's r = -0.24), resting heart rate (r = 0.10), alcohol consumption (r = 0.07), smoking (r = 0.05), and education (r = -0.23) than did body mass index. Jointly, exercise, resting heart rate, alcohol consumption, education, and age explained 18% of variance in male waist/hip ratio, but only 9% of variance in male body mass index. In women, environmental factors were more predictive for body mass index than for waist/hip ratio, with age and education being the strongest determinants. Waist/hip ratio and body mass index were approximately equally strong predictors of cardiovascular risk factor levels. The additional predictive power of waist/hip ratio over and above body mass index was tested in a hierarchical, stepwise regression. In this conservative type of analysis the increase in explained variance uniquely attributable to waist/hip ratio was 2-3% for female and 1-2% for male lipoprotein levels, and less than 0.5% for female and 0-2% for male blood pressure values.

CONCLUSIONS

The distribution of abdominal obesity in Finland is significantly influenced by health habits and sociodemographic factors in both men and women. This in turn is obviously one reason for the relatively small "independent" effect of body fat distribution on cardiovascular risk factor levels.

Obesity, blood pressure, and the sympathetic nervous system

Obesity has long been recognized as a major risk factor for the development of hypertension. Recently, insulin level has been shown to correlate with blood pressure in clinical and population-based studies. Since insulin is a major signal in the relationship between dietary intake and sympathetic nervous system activity, the possibility that insulin-mediated sympathetic stimulation is involved in the pathogenesis of hypertension in the obese has been raised. This hypothesis, developed on the basis of studies in laboratory rodents and normal human subjects, is currently being tested in the Normative Aging Study in Boston. Utilizing epidemiologic techniques applied to this defined population, evidence in support of this hypothesis has been accumulated. The preliminary results indicate that in this population, the abdominal form of obesity is associated with higher insulin levels and increased 24-hour urinary norepinephrine excretion (an index of sympathetic activity).

Measurement of blood pressure in the obese

There is a need for caution in measuring blood pressure in the obese. Problems related to adequate cuff-bladder size and shape are apparent from a review of the literature. Imperfections in experiments comparing intra-arterial/indirect blood pressure measurements remain. Cuff characteristics, as well as cuff-bladder width and length, can bias measurement of blood pressure in the obese. Authoritative committee recommendations and the differing needs of blood pressure measurement in obese adults and children still need to be rationalized. Manufacturing faults of cuff bladder and cuff availability continue to be a problem for blood pressure measurement in the obese. Measurement of blood pressure in large obese and large muscular arms may require different adjustments for cuff width and arm circumference. Nomograms for adjusting blood pressure recording in the obese are inadequate. The most important adjustment for measuring blood pressure in the obese derives from choosing the correct cuff width-arm circumference (CW/AC) ratio. Such action reduces the intersubject variability of blood pressure measurement in clinical and epidemiologic studies. Past studies probably overestimated blood pressure level in the obese and so underestimated the risk of elevated blood pressure in the obese.

[Prevalence of obesity in a locality of the State of São Paulo, Brazil, 1987]

The prevalence of obesity in Araraquara, a county of 150,000 inhabitants situated 250 km from S. Paulo, Brazil was studied. The study population, of 18-74 yrs. of age, resident in the urban area in 1987, was composed of 1,126 inhabitants, 502 males and 624 females, selected through a cluster equiprobabilistic sampling process. The prevalence of overweight (Quetelet 25-29.9 Kg/m2) was 26.9% for males and 27.7% for females. The prevalence of obesity (Quetelet equal or greater than 30.0 kg/m2) was 10.2% for males and 14.7% for females. These percentages are high when compared with those of affluent Anglo-saxon countries. The reasons for this phenomenon are discussed in the light of the fact that the economy of the city is affluent and is dependent on agroindustrial activities. When own cut-off criteria (P85 and P95 for Quetelet for 20-29 yrs of age, for each sex) are calculated, the "lean pattern" for Araraquara County is leaner than that for the a United States population. This raises doubts as to the possibility of applying cut-off criteria of particular regions to regions of different characteristics.

Body fat distribution in men with angiographically confirmed coronary artery disease

Body fat distribution and its relationship to coronary artery disease and established cardiovascular risk factors have been studied in a cohort of 286 men aged between 30 and 74 years undergoing coronary angiography. 207 (72.4%) patients showed stenosis (greater than 30%) or occlusion of one or more coronary arteries. whereas the remaining 79 (27.6%) men were free of coronary lesions and served as a control group. 112 men with angiographically defined coronary artery disease had an additional history of myocardial infarction. Body fat distribution was assessed by determining the waist-to-hip circumference ratio. A stepwise logistic regression analysis revealed that in addition to LDL-cholesterol (P = 0.0001) and age (P = 0.0005) an abdominal type of body fat distribution (P = 0.0129) is also a significant risk indicator for the occurrence of coronary artery disease (CAD) independent of body weight and other factors such as total cholesterol, HDL-cholesterol, triglycerides, insulin, systolic and diastolic blood pressure. The results of this study suggest that an abdominal type of fat distribution is associated with an increased risk of coronary artery disease.

Behavioral covariates of waist-to-hip ratio in Rancho Bernardo

We examined lifestyle and dietary habits in 685 men and 943 women (mean age 67 years) who completed an interview, examination, and food frequency questionnaire in 1984-87. Waist-to-hip ratio increased with age and body mass index in both men and women. In multiple regression, waist-to-hip ratio was independently associated with smoking, alcohol consumption, and exercise in men, and with smoking and alcohol consumption in women. The data suggest that waist-to-hip ratio is affected, at least in part, by behavioral, and potentially modifiable, factors.

Body fat distribution, blood pressure, and hypertension. A prospective cohort study of men in the normative aging study

The relation between the abdominal accumulation of body fat, blood pressure, and hypertension was assessed prospectively among 1972 male participants in the Veterans Administration Normative Aging Study. Body mass index (BMI = weight [kg]/height [m]2) and the ratio of abdominal circumference to hip breadth (AC/HB), measured at regular exams, were used as indices of total adiposity and body fat distribution, respectively. Considering blood pressure as a continuous outcome variable (in models that allowed for intraclass correlation), the AC/HB ratio was significantly positively associated with both diastolic and systolic blood pressure (P < 0.001), adjusting for age and BMI. Blood pressure was dichotomized and hypertension risk was assessed using the proportional hazards model, adjusting for age and BMI. Seven hundred cases of hypertension were recorded by study physicians during 35,496 person-years of follow-up. The risk of hypertension increased approximately three-fold (95% confidence interval, 1.7 to 5.2) with a change of one unit in the AC/HB ratio. These estimates were little changed when the effects of smoking and alcohol intake were considered. Thus, the abdominal accumulation of body fat, apart from overall level of adiposity, was associated with both increased blood pressure and an increased risk of hypertension.

The sympathoadrenal system, obesity and hypertension: an overview

Obesity-related hypertension is a clinical problem of major significance. The nature of the relationship between blood pressure and body weight has not been elucidated. Recent studies suggest that insulin (and/or insulin resistance) may be involved. An hypothesis is developed, based on the relationship between dietary intake and sympathetic activity, that attributes obesity-related hypertension to sympathetic stimulation.

Incidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women

The relation between body fat distribution, as measured by the waist-to-hip circumference ratio, and the 2-year incidences of hypertension and stroke were examined in a cohort of 41,837 women aged 55-69 years. Women who developed hypertension were 2.1 (95% confidence interval 1.7-2.6) times more likely to be in the upper tertile of waist-to-hip ratio than those who did not. Adjustment for age, body mass index (kilograms per meter squared), cigarette smoking, physical activity, alcohol intake, and education level reduced this odds ratio to 1.6 (95% confidence interval 1.3-2.1). Women who developed a stroke were also 2.1 (95% confidence interval 1.5-2.9) times more likely to be in the upper tertile of waist-to-hip ratio than those who did not. Adjustment for the same covariates also lowered this odds ratio to 1.6 (95% confidence interval 1.1-2.4). Further adjustment for hypertension and diabetes mellitus reduced the estimated risk of stroke due to elevated waist-to-hip ratio to 1.3 (95% confidence interval 0.8-2.1). Hypertension, diabetes mellitus, and cigarette smoking remained significantly associated with stroke incidence in the multivariate model. These results indicate that abdominal adiposity, as measured by an increased waist-to-hip ratio, increases the risks of hypertension and stroke, even after accounting for overall body mass. The association of abdominal adiposity with risk of stroke is related, in part, to the association of abdominal adiposity with hypertension and diabetes.

The Canadian consensus report on non-pharmacological approaches to the management of high blood pressure

The Canadian Consensus Conference on Non-Pharmacological Approaches to the Management of High Blood Pressure reviewed in March, 1989 on its meeting in Halifax, Nova Scotia, data concerning the efficacy of eight interventional strategies used for controlling hypertension. These strategies were as follows: alcohol restriction, weight reduction, physical exercise, reduction of salt intake, relaxation/stress management, increase of potassium and calcium intake and combination of pharmacological and non-pharmacological management. The Panel of the Consensus Conference recommended as efficacious the following interventions: alcohol restriction for less than two standard drinks per day, reduction of excessive body weight, and reduction of salt intake. There is sufficient scientific evidence for recommending potassium rich diet for normotensives and hypertensive persons. The Panel also concluded that a combination of pharmacological and non-pharmacological management is an efficacious measure. The Panel at this point of time could not issue recommendations as to the value of relaxation/stress management, physical exercise and calcium intake.