Body Fat Distribution and the Risk of Hypertension and Diabetes among Japanese Men and Women

Mediating effect of BMI on the association of economic status and coexistence of hypertension and diabetes in Bangladesh: A counterfactual framework-based weighting approach

Background and Aims

Non-communicable diseases such as hypertension and diabetes are matters of huge concern worldwide, with an increasing trend in prevalence over the previous decade. First of all, this study aimed to evaluate the association between economic status (ES) and body mass index (BMI), ES and comorbidity of hypertension and diabetes, and BMI and comorbidity independently. Second, it explored the mediating role of BMI in the association between ES and comorbidity of hypertension and diabetes. Finally, it investigated whether the mediating effect differs with the place of residence, gender, and education levels.

Methods

A total of 11,291 complete cases from the Bangladesh demographic and health survey 2017-18 were utilized for this study. Survey-based binary logistic regression or multiple logistic regression was used to find the association among outcome, exposure, and mediator variables, and a counterfactual framework-based weighting approach was utilized for mediation analysis.

Results

Middle-income (adjusted odds ratio [AOR]: 1.696, 95% confidence interval [CI]: 1.219, 2.360) and rich (AOR: 2.770, CI: 2.054, 3.736) respondents were more likely to have comorbidity of hypertension and diabetes compared to the poor. The odds of comorbidity increased with the increase in BMI. A positive association was observed between ES and BMI. A significant mediating role of BMI in the association between ES and comorbidity was found. We observed that 19.85% (95% CI: 11.50%, 49.6%) and 20.35% (95% CI: 14.9%, 29.3%) of total effect was mediated by BMI for middle and rich respondents, respectively, compared to the poor.

Conclusions

The mediating role of BMI was greater for female, no or primary educated respondents, and respondents from rural areas. Therefore, the study will facilitate policymakers of Bangladesh and other countries with a similar set-up to decide on health policies regarding hypertension and diabetes.

Association of waist-to-height ratio with hypertension and its subtypes in southern China

Data regarding the association of the waist-to-height ratio (WHtR) with hypertension (HTN) are conflicting. Moreover, little information is available on the association between WHtR and HTN subtypes. Therefore, we aimed to investigate the associations between WHtR and the prevalence of HTN and its subtypes in a Chinese population. In the cross-sectional analysis, 13,947 adults from the China Hypertension Survey study were analysed. We examined the relationship between WHtR and the prevalence of HTN and its subtypes (isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systodiastolic hypertension (SDH)) using multivariate logistic regression analysis. A generalized additive model (GAM) and smooth curve fitting (penalized spline method) were also used. Overall, the mean WHtR was 0.50. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for HTN, ISH, IDH and SDH for each standard deviation (SD) increase in WHtR were 1.53 (1.45-1.61), 1.36 (1.28-1.44), 1.41 (1.20-1.65) and 1.47 (1.36-1.59), respectively. The fully adjusted smooth curve fitting revealed a linear association between WHtR and HTN, ISH, IDH, and SDH. Moreover, the positive associations between WHtR and HTN and its subtypes were more strong among younger adults (<60 compared with ≥60 years, P values for interaction <0.001). These findings suggested that WHtR was positively associated with HTN and its subtypes, especially among younger adults (<60 years) in southern China.

Impact of lifestyle and psychosocial factors on the onset of hypertension after the Great East Japan earthquake: a 7-year follow-up of the Fukushima Health Management Survey

Natural disasters force many evacuees to change several aspects of their lifestyles. This longitudinal study aimed to investigate whether factors such as living environment and lifestyle factors were related to new-onset hypertension in survivors of the Great East Japan Earthquake over a long-term follow-up of up to 7 years after the earthquake. The present study examined data collected from 29,025 Japanese participants aged 39-89 years, sourced from general health checkups and the Fukushima Mental Health and Lifestyle Survey, which was conducted in 13 communities between 2011 and 2018. A total of 10,861 participants received follow-up examinations. During a median follow-up of 4.3 years, 3744 participants (1588 men, 41.4%; 2,156 women, 30.7%) had newly developed hypertension. Heavy drinking (adjusted hazard ratio 1.38, 95% confidence interval 1.21-1.57, p < 0.001) and obesity (adjusted hazard ratio 1.27, 95% confidence interval 1.19-1.37, p < 0.001) were significantly associated with new-onset hypertension after the disaster in multivariate-adjusted analysis. Furthermore, experiencing evacuation after the disaster was also significantly associated with the risk of new-onset hypertension in men (adjusted hazard ratio 1.14, 95% confidence interval 1.02-1.27, p = 0.016). The present study indicated that lifestyle factors, such as drinking and obesity, and evacuation experience in men had significant effects on the risk of new-onset hypertension in the long term after the earthquake.

Risk factors for hypertension and diabetes comorbidity in a Korean population: A cross-sectional study

Background

Hypertension and diabetes are risk factors for severe cardiovascular disease and are prevalent comorbidities. No studies have examined the associations of various risk factors related to anthropometry, bone mineral density and body composition of specific body regions with hypertension and diabetes comorbidity (HDC). This study explored the association between HDC and various risk factors related to specific body regions.

Method

A total of 7,978 subjects (3,451 men and 4,527 women) aged ≥ 50 years were included in the analysis. A binary logistic regression analysis based on complex sample data analysis was conducted to examine associations between the normal and diabetes groups, between the normal and hypertension groups, and between the normal and HDC groups.

Results

Among Korean adults aged ≥ 50 years, 11.27% of men and 10.05% of women had both diabetes and hypertension. The HDC prevalence was higher in men than in women. In men, waist-to-height ratio (WHtR, adjusted OR = 1.63 [1.22–2.18], adjusted p<0.001) exhibited a more significant association with HDC than other indices, left leg fat mass (adjusted OR = 0.61 [0.45–0.81], adjusted p = 0.0009) and right leg fat mass (adjusted OR = 0.60 [0.45–0.81], adjusted p = 0.0007) displayed strong negative associations with diabetes, and left leg lean mass (adjusted OR = 0.77 [0.67–0.89], adjusted p = 0.0002) and trunk fat mass (adjusted OR = 1.28 [1.07–1.52], adjusted p = 0.0062) were significantly associated with hypertension. In women, left leg fat mass (adjusted OR = 0.29 [0.22–0.39], adjusted p<0.0001) and right leg fat mass (adjusted OR = 0.32 [0.23–0.45], adjusted p<0.0001) exhibited strong negative associations with HDC, waist circumference (WC) (adjusted OR = 2.15 [1.40–3.30], adjusted p = 0.0005) showed a stronger association with diabetes than did other indices, and WC (adjusted OR = 1.39 [1.11–1.74], adjusted p = 0.0040) and WHtR (adjusted OR = 1.39 [1.09–1.76], adjusted p = 0.0075) were significantly associated with hypertension.

Discussion

HDC was more strongly associated with fat and lean mass than diabetes and hypertension. The association between HDC and body fat variables was more robust in women than in men.

Influence of Changes in Obesity Indicators on the Risk of Hypertension: A Cohort Study in Southern China

OBJECTIVES

The objective of this study was to demonstrate the association between changes in different obesity indicators and the risk of incident hypertension by the age-group among community-dwelling residents in southern China.

METHODS

A total of 6,959 non-hypertensive participants aged ≥18 years old were enrolled in this cohort study and completed questionnaire interviews and anthropometric measurements at baseline (2010) and follow-up (2017). A time-dependent covariate Cox proportional hazard model considered the changes in obesity indicators during the follow-up period and calculated the hazard ratios (HRs) to analyze the risk of incident hypertension according to different obesity indicators.

RESULTS

During a mean follow-up of 7.1 years, 1,904 participants were newly diagnosed with hypertension. The body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were significantly positively associated with an increased future risk of incident hypertension, and BMI was the best predictive indicator of hypertension (obesity in men: HR = 2.65, 95% confidence interval (CI) = 2.20-3.20; obesity in women: HR = 2.80, 95% CI = 2.27-3.45). Compared with the middle-aged and older group, the risk of incident hypertension was highest in the younger group which had the highest baseline obesity indicators.

CONCLUSIONS

Changes in obesity indicators were significantly associated with the risk of incident hypertension in all age-groups, and the risk of future incident hypertension increased with the increase in baseline obesity indicators.

Causal Effect of Adiposity Measures on Blood Pressure Traits in 2 Urban Swedish Cohorts: A Mendelian Randomization Study

Background Different adiposity traits may be causally related to hypertension in different ways. By using genetic variants as randomly allocated proxies for studying the effect of modifying adiposity traits, the Mendelian randomization approach can be used to investigate this. Methods and Results In this study, we used 4 different genetic risk scores (GRS; GRS-BMI₅₆₅, GRS-WHR₃₂₄, GRS-VAT₂₀₈, GRS-BF₈₁) including hundreds of single nucleotide polymorphisms associated with body mass index, waist-to-hip ratio, visceral adipose tissue, and body fat, respectively. These were applied as instrumental variables in Mendelian randomization analyses. Two Swedish urban-based cohort studies, the Malmö Diet and Cancer, and the Malmö Preventive 795Projects were used to obtain genetic association estimates with blood pressure (BP). In both the Malmö Preventive Projects and Malmö Diet and Cancer studies, except for that for body fat, all of the genetic risk scores were significantly associated with systolic BP and diastolic BP, but with different magnitudes. In particular, in both cohorts, each standard deviation increase in the genetic risk score made up by the 324 single nucleotide polymorphisms associated with waist-to-hip ratio was associated with doubling of the likelihood of hypertension prevalence at baseline. However, only the genetic risk score made up by the 565 SNPs associated with body mass index was significantly associated with hypertension incidence during 23.6±4.3 years of follow-up in the Malmö Preventive Project. Conclusions We support a causal link between genetically mediated adiposity, especially waist-to-hip ratio and body mass index, and BP traits including hypertension prevalence and, for the first time to our knowledge, hypertension incidence. The differences in magnitude between these associations might suggest different mechanisms by which different adiposity affects BP/hypertension and consequently may indicate that tailored interventions are needed to reduce cardiovascular risk.

Analyzing Trio-Anthropometric Predictors of Hypertension: Determining the Susceptibility of Blood Pressure to Sexual Dimorphism in Body Stature

Background

Several studies had suggested that complex body stature could be a risk factor of hypertension.

Objectives

We aim to correlate body mass index (BMI), waist-hip ratio (WHR), and waist-height ratio (WHtR) of rural dwellers in Afikpo community, Ebonyi State, Nigeria, with blood pressure parameters. Furthermore, we aim to ascertain how each of the anthropometric variables affects blood pressure in men and women, respectively.

Materials and Methods

A sample of 400 (200 males and 200 females) adults aged 18–89 years were selected for the correlation cross-sectional study. Data for weight, height, waist, and hip circumferences were collected by means of anthropometric measurement protocol with the aid of a calibrated flexible tape and health scale and mercury sphygmomanometer for measurement of blood pressure. A participant was classified as being hypertensive if systolic blood pressure (SBP) was >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. Pulse pressure was recorded as the numeric difference of SBP and DBP.

Results

The result revealed that male BMI and WHR were higher than those of females while female WHtR was higher than that of males (P < 0.01). The prevalence of hypertension failed to correlate with sex among participants in the study (χ² = 0.567; P < 0.05). Variation in SBP and DBP of both sexes was dependent on BMI, WHtR, and waist and hip circumference, but not on WHR. The SBP of both sexes and female pulse pressure did correlate with age (P < 0.001). Waist circumference, BMI, and WHtR correctly predicted the variations in SBP, DBP, and pulse pressure.

Conclusion

The strength of association of BMI, WHtR, and waist girth with SBP and DBP of both sexes was robust and similar, but inconsistent with WHR. Thus, a simple estimation of the trio-anthropometric predictors could serve as a means for routine check or preliminary diagnosis of a patient with hypertension.

Impacts of the urinary sodium-to-potassium ratio, sleep efficiency, and conventional risk factors on home hypertension in a general Japanese population

Recently, a high urinary sodium-to-potassium (Na/K) ratio and reduced sleep efficiency, in addition to conventional risk factors (obesity and excess alcohol intake), have been identified as risk factors for hypertension. We estimated the population attributable fraction (PAF) for home hypertension due to these risk factors in a general Japanese population. We conducted a cross-sectional study including 1384 participants (393 men and 991 women) to estimate the odds ratio (OR) and 95% confidence interval (CI) for the presence of any of the conventional risk factors using multivariable logistic regression analyses. The models were adjusted for sex, age, smoking status, and log-transformed average daily steps. We also estimated the OR and 95% CI for the presence of any of the overall risk factors. Furthermore, we calculated the PAF due to these risk factors. The results showed that the prevalence of home hypertension was 39.0% (540/1384). The presence of any of the conventional risk factors, as well as any of the overall risk factors, was significantly associated with an increased prevalence of hypertension (OR 2.80, 95% CI 2.15-3.65; OR 2.50, 95% CI 1.93-3.22, respectively). The PAF for hypertension due to the presence of any of the conventional risk factors and the PAF due to the presence of any of the overall risk factors were 30.2% and 39.0%, respectively. In conclusion, the impact of the overall risk factors, including the urinary Na/K ratio and sleep efficiency, on home hypertension was higher than that of conventional risk factors alone. The management of the urinary Na/K ratio and sleep efficiency as well as conventional risk factors might be important in the management of blood pressure.

Anthropometric Indexes for Predicting High Blood Pressure in Vietnamese Adults: A Cross-Sectional Study

Background

The rate of hypertension and obesity is increasing in Vietnamese society. This study aimed to focus on assessing the relationship between anthropometric indexes (body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR)) and high blood pressure to determine which is the best predictor for high blood pressure among adults over 18 years in Vietnam.

Methods

A cross-sectional study of 1636 people was conducted. People who were over 18 years old, healthy or had hyperlipidemia and on the treatment were recruited. Patients with cancer, heart disease, diabetes, kidney disease, and hypertension were excluded. Information on demographics, smoking and drinking habits, weight, height, waist circumference, and blood pressure was collected. Areas under receiver operating characteristic curves (AUCs) were examined to determine the predictability of anthropometric indicators for high blood pressure in men and women. Logistic regression analysis, stratified by gender, was performed to examine the association between anthropometric indexes and high blood pressure.

Results

In this study, the percentage of people with high blood pressure was 10.51%. The AUC for the WHtR was significantly greater than for the BMI for both genders. Logistic regression demonstrated that only WHtR had a significant positive association with high blood pressure among women. The optimal WHtR cut-off value for predicting high blood pressure in men and women were 0.47 and 0.50, respectively.

Conclusion

Among the indicators analyzed in this study, WHtR was the best for the predicting of the presence of high blood pressure, in both men and women. However, WHtR could only explain the changes of high blood pressure in women.

Obesity markers for the prediction of incident type 2 diabetes mellitus in resource-poor settings: The CRONICAS Cohort Study

AIMS

To determine the predictive performance of well-known obesity markers: body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR), and total body fat percentage (TBF%), to identify incident cases of type 2 diabetes mellitus T2DM.

METHODS

Secondary data analysis of the CRONICAS Cohort Study, conducted in 3 regions of Peru. Participants without T2DM at baseline were selected for analyses. The obesity markers were evaluated at the beginning of the study, and the development of T2DM was determined at 30 months of follow-up. The predictive performance of the markers was calculated using areas under the curve (AUC), and sensitivity and specificity of the best cutoff points were estimated.

RESULTS

A total of 2510 participants with no diabetes at baseline, median age 54.1 years (inter-quartile range: 44.6 to 63.5), were included in the analysis. The cumulative incidence of T2DM at 30 months of follow-up was 4.7%. All the AUC studied for obesity markers and TBF% were poor.

CONCLUSIONS

We found that obesity markers had a poor predictive performance (AUC) for the incidence of T2DM when used alone. The BMI, WC and WHtR had better performance for the incidence of T2DM relative to the WHR among women, and no differences in performance between obesity markers were found among men.

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.

Sex Differences in the Effects of Weight Reduction on Future Blood Pressure Elevation in a Mildly Obese Middle-Aged Population

Background: The effectiveness of weight loss (WL) in preventing blood pressure (BP) elevation is common knowledge; however, the effect of sex differences is not known.

Methods and Results: Health checkup data from Kagoshima Kouseiren Medical Healthcare Center for middle-aged participants (40–49 years old) with mild obesity (body mass index [BMI] 25.0–29.9 kg/m²) who had examination data for 2 follow-up time-points (after 3 and 10 years) were analyzed. Propensity score (PS) matching using data from the first examination was used to match participants with a decrease in BMI ≥1.0 kg/m² at 3 years (WL group) with those with a BMI decrease <1.0 kg/m² or weight gain (non-WL group). BP values were compared after 3 and 10 years between the 2 groups, as was the prevalence of hypertension after 10 years. PS matching resulted in 232 men and 160 women in each group. Among women, systolic BP (SBP) and hypertension prevalence after 10 years were significantly lower in the WL than non-WL group (P<0.01 and P<0.05, respectively). There were no significant differences in SBP and hypertension prevalence after 10 years in men in the 2 groups.

Conclusions: There were sex differences in the effectiveness of WL in preventing future BP elevation in mildly obese middle-aged participants: WL prevented future BP elevation and hypertension onset in women, but not in men.

[Factors associated with arterial hypertension: a systematic review]

A systematic review of demographic, socioeconomic, behavioral and anthropometric factors associated with hypertension. We included observational studies, of populations aged 18 or older, from the past ten years, published in English, Portuguese or Spanish from Pubmed, Web of Science, Scopus and Lilacs bases. The most found factors related to the greater chance of having hypertension were age and the Body Mass Index (BMI). Other factors associated with the disease were: gender (male), education (lower education), income (lower income) and waist circumference (high). Never having smoked, never having consumed alcohol and white skin color were characteristics related to a lower chance of having hypertension. As demonstrated, demographic, socioeconomic, behavioral and anthropometric characteristics are important factors associated with a greater chance of having hypertension in the adult population. However, while most of the factors associated with it are amenable to intervention, broader health promotion policies will be needed to reduce socioeconomic inequalities in the prevalence of the disease.

Usefulness of waist-to-height ratio in screening incident hypertension among Japanese community-dwelling middle-aged and elderly individuals

Background

The incidence of hypertension is increasing worldwide and obesity is one of the most significant risk factors. Obesity can be defined by various anthropometric indices such as body mass index (BMI), waist-to-hip ratio (WHpR), and waist-to-height ratio (WHtR). This study examined a range of anthropometric indices and their relationships with hypertension.

Methods

This study included 768 men aged 70 ± 10 years and 959 women aged 70 ± 8 years from a rural village. The relationship between anthropometric indices (BMI, WHpR, and WHtR) and hypertension was examined using cross-sectional (baseline, N = 1727) and cohort data (follow-up, N = 419). Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in both genders. Logistic regression models were used to evaluate WHtR as a significant predictor of hypertension.

Results

In the cross-sectional study, WHtR, BMI, and WHpR showed significant predictive abilities for hypertension in both genders, with WHtR showing the strongest predictive ability. Also, in the cohort study, WHtR showed a significant predictive ability for incident hypertension in both genders, and, for women, BMI as well as WHtR had also predictive ability. In the cross-sectional study, the optimal WHtR cutoff values were 0.53 (sensitivity, 44.3%; specificity, 80.2%) for men and 0.54 (sensitivity, 60.9%; specificity, 68.6%) for women. In the cohort study, the optimal WHtR values were 0.47 (sensitivity, 85.4%; specificity, 39.8%) for men and 0.51 (sensitivity, 66.7%; specificity, 58.2%) for women.

Conclusions

The results suggest that WHtR is a useful screening tool for hypertension among Japanese middle-aged and elderly community-dwelling individuals.

Joint Effects of Body Mass Index and Waist Circumference on the Incidence of Hypertension in a Community-Based Chinese Population

OBJECTIVE

We aimed to investigate the relationships of body mass index (BMI), waist circumference (WC), and obesity defined using a combination of both indexes, with the incidence of hypertension in a Chinese community-based population.

METHODS

A total of 1,927 Chinese participants (57.2 ± 8.9 years old) with normal blood pressure at baseline were recruited from the Shijingshan community in Beijing. Incident hypertension was defined as blood pressure ≥140/90 mm Hg, self-reported hypertension, or the use of any antihypertensive medication at the follow-up visit.

RESULTS

During 2.3 years of follow-up, 19.1% (n = 97) of the men and 13.6% (n = 158) of the women developed incident hypertension. The adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for obesity (BMI ≥30) were 3.49 (1.59-7.66) and 2.60 (1.48-4.55) for men and women, respectively. A 1-point increase in BMI was associated with 8% (OR = 1.08, 95% CI: 1.00-1.17) and 10% (OR = 1.10, 95% CI: 1.05-1.16) increases in the incidence of hypertension in men and women, respectively. Abdominal obesity (WC ≥90 cm in men and ≥85 cm in women) was positively associated with incident hypertension in both men (adjusted OR = 1.79, 95% CI: 1.10-2.91) and women (adjusted OR = 1.61, 95% CI: 1.09-2.40). A 1-cm increase in WC was associated with 4% (adjusted OR = 1.04, 95% CI: 1.01-1.07) and 4% (adjusted OR = 1.04, 95% CI: 1.02-1.07) increases in the incidence of hypertension in men and women, respectively. The combination of abnormal BMI and WC has the highest risk for hypertension in both men (adjusted OR = 3.10, 95% CI: 1.48-6.50) and women (adjusted OR = 2.51, 95% CI: 1.43-4.40).

CONCLUSIONS

This study shows that BMI, WC, and an index that combined the two are independently associated with incident hypertension in a Chinese community-based population.

Skinfold thickness and the incidence of type 2 diabetes mellitus and hypertension: an analysis of the PERU MIGRANT study

OBJECTIVE

To determine the association between excess body fat, assessed by skinfold thickness, and the incidence of type 2 diabetes mellitus (T2DM) and hypertension (HT).

DESIGN

Data from the ongoing PERU MIGRANT Study were analysed. The outcomes were T2DM and HT, and the exposure was skinfold thickness measured in bicipital, tricipital, subscapular and suprailiac areas. The Durnin-Womersley formula and SIRI equation were used for body fat percentage estimation. Risk ratios and population attributable fractions (PAF) were calculated using Poisson regression.

SETTING

Rural (Ayacucho) and urban shantytown district (San Juan de Miraflores, Lima) in Peru.

PARTICIPANTS

Adults (n 988) aged ≥30 years (rural, rural-to-urban migrants, urban) completed the baseline study. A total of 785 and 690 were included in T2DM and HT incidence analysis, respectively.

RESULTS

At baseline, age mean was 48·0 (sd 12·0) years and 47 % were males. For T2DM, in 7·6 (sd 1·3) years, sixty-one new cases were identified, overall incidence of 1·0 (95 % CI 0·8, 1·3) per 100 person-years. Bicipital and subscapular skinfolds were associated with 2·8-fold and 6·4-fold risk of developing T2DM. On the other hand, in 6·5 (sd 2·5) years, overall incidence of HT was 2·6 (95 % CI 2·2, 3·1) per 100 person-years. Subscapular and overall fat obesity were associated with 2·4- and 2·9-fold risk for developing HT. The PAF for subscapular skinfold was 73·6 and 39·2 % for T2DM and HT, respectively.

CONCLUSIONS

We found a strong association between subscapular skinfold thickness and developing T2DM and HT. Skinfold assessment can be a laboratory-free strategy to identify high-risk HT and T2DM cases.

Association and Interaction Analysis of Body Mass Index and Triglycerides Level with Blood Pressure in Elderly Individuals in China

Objectives

To assess the extent of interaction between body mass index (BMI) and triglyceride (TG) level and its effects on blood pressure (BP) in elderly individuals in China.

Design

Cross-sectional study.

Setting

Data were taken from a cross-sectional study called the China Health and Retirement Longitudinal Study.

Participants

The analytic sample included 3629 subjects aged 45 to 96 years.

Main Outcome Measurements

Data were obtained from the China Health and Retirement Longitudinal Study, which is a cross-sectional study. Age-adjusted partial Pearson's correlation test was used to compare various characteristics and BP. Adjusted associations were first used as linear regression models, as appropriate. Then, general linear models adjusted for related potential confounders were used to examine the synergistic effects of BMI and TG level on BP. Finally, a binary logistic regression model adjusted for confounding factors was used to examine the association between BMI or TG level and hypertension.

Results

Age-adjusted partial Pearson's correlation coefficient showed that the TG level was positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women with BMI < 24.0 kg/m²; however, TG level was positively correlated with DBP in women with BMI ≥ 24.0 kg/m² but not with DBP in men with BMI ≥ 24.0 kg/m². Multiple linear regression analysis showed that BMI level was significantly and positively associated with both SBP and DBP in men and women with BMI < 24.0 kg/m², and TG level was significantly and positively associated with SBP in women with BMI < 24.0 kg/m², independent of other confounding factors. A general linear model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, eating habits, taking activities, antidiabetic medication, antihypertensive therapy, fasting plasma glucose [FPG], low-density lipoprotein cholesterol [LDL-C], estimated glomerular filtration rate [eGFR], and serum uric acid [SUA]) showed no interaction between BMI and TG level and SBP (men, β = 0.572, P = 0.845; women, β = 0.122, P = 0.923) and DBP (men, β = -0.373, P = 0.810; women, β = 0.272, P = 0.828). A binary logistic regression model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, drinking, eating habits, taking activities, major accidental injury, physical activity, history of cardiovascular disease, history of liver disease, antilipidemic medication, antidiabetic medication, antihypertensive therapy, FPG, LDL-C, high-density lipoprotein cholesterol [HDL-C], eGFR, and SUA) showed that overweight and obese men and women were more likely to have hypertension (men: odds ratio [OR] = 1.781, 95% confidence interval [CI] = 1.393–2.277; women: OR = 1.653, 95% CI = 1.330–2.055) and women with high TG were more likely to have hypertension (OR = 1.558, 95% CI = 1.219–1.992).

Conclusion

An interactive effect of BMI and TG level on BP was not observed in either men or women; however, independent effects of BMI on BP were observed in both men and women, and an association between TG level and hypertension was observed in women.

Associations of anthropometric adiposity indexes with hypertension risk: A systematic review and meta-analysis including PURE-China

BACKGROUND AND OBJECTIVE

The association between hypertension and obesity has been confirmed, while no agreement has been reached about which anthropometric adiposity index is the best. This meta-analysis aimed to perform a systematic review and meta-analysis on the associations of hypertension risk with body mass index (BMI), waist circumstance (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR), and a prospective urban and rural epidemiology study from China (PURE-China) was added into this meta-analysis as an individual study.

METHODS

Systematic literature searching was conducted to identify relevant articles published up to September 2018 in CNKI, WANFANG Data, Web of Science, SinoMed, PubMed, MEDLINE, EMBASE, Cochrane Library and cross-referencing. Literature reporting the association of hypertension risk with BMI, WC, WHR, and WHtR were defined as eligible. PURE-China data were analyzed and included as 1 eligible study into meta-analyses. Summary odds ratio (OR) and area under receiver operating characteristic curve (AUC) were pooled using meta-analysis methods. Heterogeneity and publication bias were evaluated. Subgroups based on gender, country and study design were conducted as well.

RESULTS

Thirty-eight original articles including PURE-China were included into meta-analyses, involving 309,585 subjects. WHtR had the strongest association with hypertension risk (OR, 1.68; 95% confidence interval, [CI]:1.29-2.19) and prediction ability (AUC, 70.9%; 95% CI: 67.8%-74.2%), which were also confirmed in subgroup analyses based on gender and country. However, BMI was found to have the highest prediction ability in adjusted models of PURE-China and followed WC, both of which were superior to WHtR (73.7% and 73.4% vs 73.2%).

CONCLUSIONS

Our overall meta-analysis further confirmed WHtR as a good indicator at discriminating those individuals at increased risk of hypertension, and in some cases, it is better than BMI, WC, and WHR.

Waist-to-height ratio index for predicting incidences of hypertension: the ARIRANG study

BACKGROUND

Several anthropometric indices such as body mass index (BMI) and waist circumference (WC) have been examined as indicators of cardiovascular diseases, in both adults and children. However, the waist-to-height ratio (WHtR) is considered a better predictor for the detection of cardiovascular risk factors, than BMI. We investigated the association between the WHtR and incident hypertension.

METHODS

A total of 1718 participants, aged 39-72 years, were recruited in this longitudinal study. Participants were divided into 2 groups according to the development of hypertension during 2005-2008 (baseline) and 2008-2011 (follow-up). Logistic regression models were used to evaluate the WHtR as a significant predictor of hypertension.

RESULTS

During the 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were diagnosed, with an incidence rate of approximately 4% per year. The WHtR was significantly higher in the participants who had developed hypertension than in those who had not (0.54 ± 0.05 vs. 0.51 ± 0.05, p < 0.001). After adjusting for age, sex, smoking status, alcohol intake, regular exercise status, total cholesterol, and systolic blood pressure, at the baseline, the logistic regression analysis indicated that the participants with the highest quartile of the WHtR (WHtR≥0.54) were 4.51 times more likely to have hypertension than those with the lowest quartile (odds ratio 4.51; 95% confidence interval 2.41-8.43; p < .0001). The area under the curve for the WHtR, in identifying hypertension risk, was significantly greater than that for the BMI (p = 0.0233).

CONCLUSION

A positive association between WHtR and the incidence of hypertension was observed in Korean adults. The findings of the present community-based prospective study suggest that the WHtR may be a better predictor of incident hypertension.

Optimal cut-points of different anthropometric indices and their joint effect in prediction of type 2 diabetes: results of a cohort study

Background

To determine the anthropometric indices that would predict type 2 diabetes (T2D) and delineate their optimal cut-points.

Methods

In a cohort study, 7017 Iranian adults, aged 20–60 years, free of T2D at baseline were investigated. Using Cox proportional hazard models, hazard ratios (HRs) for incident T2D per 1 SD change in body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), waist to hip ratio (WHR), and hip circumference (HC) were calculated. The area under the receiver operating characteristics (ROC) curves (AUC) was calculated to compare the discriminative power of anthropometric variables for incident T2D. Cut-points of each index were estimated by the maximum value of Youden’s index and fixing the sensitivity at 75%. Using the derived cut-points, joint effects of BMI and other obesity indices on T2D hazard were assessed.

Results

During a median follow-up of 12 years, 354 men, and 490 women developed T2D. In both sexes, 1 SD increase in anthropometric variables showed significant association with incident T2D, except for HC in multivariate adjusted model in men. In both sexes, WHtR had the highest discriminatory power while HC had the lowest. The derived cut-points for BMI, WC, WHtR, WHR, and HC were 25.56 kg/m², 89 cm, 0.52, 0.91, and 96 cm in men and 27.12 kg/m², 87 cm, 0.56, 0.83, and 103 cm in women, respectively. Assessing joint effects of BMI and each of the obesity measures in the prediction of incident T2D showed that among both sexes, combined high values of obesity indices increase the specificity for the price of reduced sensitivity and positive predictive value.

Conclusions

Our derived cut-points differ between both sexes and are different from other ethnicities.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5611-6) contains supplementary material, which is available to authorized users.

Identical anthropometric characteristics of impaired fasting glucose combined with impaired glucose tolerance and newly diagnosed type 2 diabetes: anthropometric indicators to predict hyperglycaemia in a community-based prospective cohort study in southwest China

OBJECTIVES

To assess the anthropometric characteristics of normoglycaemic individuals who subsequently developed hyperglycaemia, and to evaluate the validity of these measures to predict prediabetes and diabetes.

DESIGN

A community-based prospective cohort study.

PARTICIPANTS

In total, 1885 residents with euglycaemia at baseline from six communities were enrolled.

SETTING

Sichuan, southwest China.

PRIMARY OUTCOME MEASURES

The incidences of prediabetes and diabetes were the primary outcomes.

METHODS

The waist-to-height ratio (WHtR), body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) of all participants were measured at baseline and during follow-up. A 75 g glucose oral glucose tolerance test was conducted at each survey.

RESULTS

During a median of 3.00 (IQR: 2.92-4.17) years follow-up, the cumulative incidence of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT), IFG combined with IGT (IFG+IGT), and newly diagnosed diabetes mellitus (NDDM) were 8.44%, 18.14%, 8.06% and 13.79%, respectively. WHtR, BMI, WC and WHR were significantly different among subjects who subsequently progressed to isolated IFG or IGT, IFG+IGT or NDDM (p<0.05). The anthropometric characteristics of IFG+IGT subjects were similar to those of the NDDM population (p>0.005). All the baseline anthropometric measurements were useful for the prediction of future prediabetes and NDDM (p<0.05). The optimal thresholds for the four measurements were calculated for the prediction of hyperglycaemia, with a WHtR value of 0.52 performing best to identify isolated IFG or IGT, IFG+IGT and NDDM.

CONCLUSIONS

Anthropometric measures, especially WHtR, could be used to predict hyperglycaemia 3 years in advance. Distinct from isolated IFG and IGT, the individuals who developed combined IFG+IGT had identical anthropometric profiles to those who progressed to NDDM.

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.

Comparison of various anthropometric indices for the identification of a predictor of incident hypertension: the ARIRANG study

We compared the predictive capability of weight, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), body mass index (BMI), body roundness index (BRI), and a body shape index (ABSI) to identify incident hypertension, and to determine whether any of these indices may be used as a better single predictor of incident hypertension. A total of 1718 participants aged 39-72 years were collected  in a longitudinal study. Logistic regression models were used to evaluate various anthropometric indices as significant predictors of hypertension. During 2.8 years of follow-up, 185 new cases of hypertension (10.8%) were reported. The BRI and ABSI were significantly higher in the participants who had developed hypertension than in those who had not (4.15 ± 1.01 vs. 3.57 ± 1.03, 0.80 ± 0.04 vs. 0.78 ± 0.05; respectively, p < 0.001). After adjusting for confounding variables, logistic regression analysis indicated that participants within the highest quartile of WC and WHtR were 4.79 and 4.51 times more likely to have hypertension than those within the lowest quartile (OR 4.79, 95% CI 2.49-9.20 vs. OR 4.51, 95% CI 2.41-8.43, respectively, p < 0.0001); in contrast, no such correlation was found for BMI, WHR, BRI, and ABSI. WC (AUC: 0.672) showed a more powerful predictive ability for hypertension (p < 0.0001) than BMI (AUC: 0.623), and an equal predictive power for hypertension as WHtR (AUC: 0.662) and BRI (AUC: 0.662) in the general population. We concluded that WC and/or WHtR but not BMI, showed superior prediction capability compared to WHR, BRI, and ABSI, for determining the incidence of hypertension in a community-based prospective study.

Is waist-to-height ratio the best predictive indicator of hypertension incidence? A cohort study

BACKGROUND

The best anthropometric indicator to verify the association between obesity and hypertension (HTN) has not been established. We conducted this study to evaluate and compare the discriminatory power of waist-to-height ratio (WHtR) in relation to body mass index (BMI) and waist circumference (WC) in predicting HTN after 13 years of follow-up.

METHODS

This study was an observational prospective cohort study performed in the city of Firminópolis, in Brazilian's midwest. The cohort baseline (phase 1) was initiated in 2002 with the evaluation of a representative sample of the normotensive population (≥ 18 years of age). The incidence of HTN was evaluated as the outcome (phase 2). Sociodemographic, dietary and lifestyle variables were used to adjust proportional hazards models and evaluate risk of HTN according to anthropometric indices. The areas under the receiver operating characteristic (ROC) curves were used to compare the predictive capacity of these indices. The best HTN predictor cut-offs were obtained based on sensitivity and specificity.

RESULTS

A total of 471 patients with a mean age of 38.9 ± 12.3 years were included in phase 1. The mean follow-up was 13.2 years, and 207 subjects developed HTN. BMI, WC and WHtR were associated with risk of HTN incidence and had similar power in predicting the disease. However, the associations were only significant for women. The cut-off points with a better HTN predictive capacity were in agreement with current recommendations, except for the WC in men.

CONCLUSIONS

The results suggest that both overall obesity (BMI) and central obesity (WC and WHtR) anthropometric indicators can be used in this population to evaluate the risk of developing hypertension.

High fat diet induced atherosclerosis is accompanied with low colonic bacterial diversity and altered abundances that correlates with plaque size, plasma A-FABP and cholesterol: a pilot study of high fat diet and its intervention with Lactobacillus rhamnosus GG (LGG) or telmisartan in ApoE-/- mice

BACKGROUND

Atherosclerosis appears to have multifactorial causes - microbial component like lipopolysaccharides (LPS) and other pathogen associated molecular patterns may be plausible factors. The gut microbiota is an ample source of such stimulants, and its dependent metabolites and altered gut metagenome has been an established link to atherosclerosis. In this exploratory pilot study, we aimed to elucidate whether microbial intervention with probiotics L. rhamnosus GG (LGG) or pharmaceuticals telmisartan (TLM) could improve atherosclerosis in a gut microbiota associated manner.

METHODS

Atherosclerotic phenotype was established by 12 weeks feeding of high fat (HF) diet as opposed to normal chow diet (ND) in apolipoprotein E knockout (ApoE^-/-) mice. LGG or TLM supplementation to HF diet was studied.

RESULTS

Both LGG and TLM significantly reduced atherosclerotic plaque size and improved various biomarkers including endotoxin to different extents. Colonial microbiota analysis revealed that TLM restored HF diet induced increase in Firmicutes/Bacteroidetes ratio and decrease in alpha diversity; and led to a more distinct microbial clustering closer to ND in PCoA plot. Eubacteria, Anaeroplasma, Roseburia, Oscillospira and Dehalobacteria appeared to be protective against atherosclerosis and showed significant negative correlation with atherosclerotic plaque size and plasma adipocyte - fatty acid binding protein (A-FABP) and cholesterol.

CONCLUSION

LGG and TLM improved atherosclerosis with TLM having a more distinct alteration in the colonic gut microbiota. Altered bacteria genera and reduced alpha diversity had significant correlations to atherosclerotic plaque size, plasma A-FABP and cholesterol. Future studies on such bacterial functional influence in lipid metabolism will be warranted.

Relationship of BMI to the incidence of hypertension: a 4 years' cohort study among children in Guangzhou, 2007-2011

Background

In China, there has been a dramatic increase in overweight and obesity among children and adolescents in recent decades. However, little longitudinal studies reported BMI in relation to the risk for hypertension among children in China. We examined the longitudinal relations between BMI and hypertension in Chinese schoolchildren via a retrospective cohort study.

Methods

The cohort study was carried out in 7203 children (3821 boys and 3382 girls) in Guangzhou aged 6–8 years, with a continuous 4 years of follow-up. The participants, evaluated by body mass index (BMI), were categorized as thinness, normal weight, overweight, and obesity groups. The age and gender-specific BMI cutoffs newly developed by the Working Group on Obesity in China (WGOC) were used to define overweight and obesity. The thinness was defined by the international age- and gender-specific cut-off points for BMI for thinness grade 1. Hypertension was defined by using percentiles of systolic and diastolic values on the basis of height percentile, age, and gender. The Cox proportional hazards model was used to estimate the single or joint effect of BMI on the risk of hypertension. This study was approved by The Ethical Committee of School of Public Health, Sun Yat-sen University.

Results

During a follow-up of 4 years, a shocking high cumulative incidence of hypertension was found in Chinese overweight (50.1 %) and obesity (70 %) schoolchildren. The incidence of children hypertension were markedly higher among overweight and obesity group than normal weight and thinness group (24.3 %, 18.5 % vs 11.1 %, 7.4 %). Compared with the children in the normal weight group, the adjusted HRs and 95 % CIs of developing hypertension in thinness, overweight, and obesity group were 0.972 (0.851, 1.110), 1.313 (1.179, 1.461), and 1.816 (1.634, 2.081), respectively. Additionally, the protective effect of thinness on hypertension was observed in boys 0.808 (0.666, 0.981), but not in girls 1.158 (0.966, 1.389).

Conclusions

The 4-year longitudinal study indicated that the overweight and obesity can predict the higher risk of hypertension in Chinese children, whereas, the thinness predict the lower risk of hypertension only in boys.

Associations Between Hypertension and Body Mass Index and Waist Circumference in U.S. Adults: A Comparative Analysis by Gender

INTRODUCTION

The body mass index (BMI) and waist circumference (WC) are a risk of hypertension, but their potentially multiplicative effect on hypertension is underexplored.

AIM

To examine modifying effects of BMI and WC on hypertension using a nationally representative U.S. adult sample stratified by gender.

METHODS

Data were derived from the 2009-2010 NHANES. Overweight and obesity were based on BMI of 25.0-29.9 and ≥30 kg/m(2), respectively. High-risk WC was based on ≥102.0 and ≥88.0 cm for males and females, respectively. Hypertension was determined by systolic/diastolic blood pressure of ≥140/≥90 mmHg, or taking prescribed medications. Logistic regression was used to examine the association between hypertension and BMI and WC by gender. Interaction terms were added to examine if BMI modified the effect of WC on hypertension.

RESULTS

Both BMI and WC were significant predictors of hypertension in overall population. Gender-specific models indicated that BMI played an important role in hypertension risk among males, but WC in females. The interaction effects were present among males implying that the association of WC with hypertension was stronger if subjects were overweight or obese. This effect, however, was not present in females.

CONCLUSION

BMI and WC may influence hypertension differently among males and females.

Longitudinal association of anthropometric measures of adiposity with cardiometabolic risk factors in postmenopausal women

PURPOSE

Some studies suggest that anthropometric measures of abdominal obesity may be superior to body mass index (BMI) for the prediction of cardiometabolic risk factors; however, most studies have been cross-sectional. Our aim was to prospectively examine the association of change in BMI, waist-to-hip ratio (WHR), waist circumference (WC), and waist circumference-to-height ratio (WCHtR) with change in markers of cardiometabolic risk in a population of postmenopausal women.

METHODS

We used a subsample of participants in the Women's Health Initiative aged 50 to 79 years at entry with available fasting blood samples and anthropometric measurements obtained at multiple time points over 12.8 years of follow-up (n = 2672). The blood samples were used to measure blood glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides at baseline, and at years 1, 3, and 6. We conducted mixed-effects linear regression analyses to examine associations at baseline and longitudinal associations between change in anthropometric measures and change in cardiometabolic risk factors, adjusting for covariates.

RESULTS

In longitudinal analyses, change in BMI, WC, and WCHtR robustly predicted change in cardiometabolic risk, whereas change in WHR did not. The strongest associations were seen for change in triglycerides, glucose, and HDL-C (inverse association).

CONCLUSION

Increase in BMI, WC, and WCHtR strongly predicted increases in serum triglycerides and glucose, and reduced HDL-C. WC and WCHtR were superior to BMI in predicting serum glucose, HDL-C, and triglycerides. WCHtR was superior to WC only in predicting serum glucose. BMI, WC, and WCHtR were all superior to WHR.

Waist-to-height ratio is an appropriate index for identifying cardiometabolic risk in Chinese individuals with normal body mass index and waist circumference

BACKGROUND

The waist-to-height ratio (WHtR), a novel index that has been reported to correlate more strongly than body mass index (BMI) and waist circumference (WC) with cardiometabolic risk factors, has not been studied in Chinese individuals with normal body mass index and waist circumference. The present study compared the predictive power of WHtR with those of BMI and WC for such factors in non-obese Chinese, and to define optimal cutoffs of WHtR in this population.

METHODS

A total of 2137 subjects aged 40-75 years were recruited. Three anthropometric indices (WHtR, BMI, and WC) were compared and the optimal cutoffs of WHtR were identified by receiver operating characteristic curve (ROC) analysis. WHtR was divided into four quartiles (WHtR-Q), and multiple linear regression analyses were used to calculate the relationship between WHtR-Q and clinical biochemical index.

RESULTS

Waist-to-height ratio was more efficient than WC to identify cardiometabolic risk factors in both genders, but was only superior to BMI in females. WHtR-Q was positively correlated with fasting plasma glucose, 2-h postprandial blood glucose, and systolic blood pressure, and negatively connected with high density lipoprotein cholesterol in both genders after controlling for age, current smoking and drinking, moderate-intensity physical activity, daily sedentary time, daily screen time and menopause (only for females). The optimal cutoffs of WHtR for detecting cardiometabolic risk factors were 0.47 in males and 0.51 in females.

CONCLUSION

Waist-to-height ratio might be an effective index to identify cardiometabolic risk factors in Chinese with normal BMI and WC, particularly in females.

Predicting cardiometabolic risk: waist-to-height ratio or BMI. A meta-analysis

BACKGROUND AND OBJECTIVES

The identification of increased cardiometabolic risk among asymptomatic individuals remains a huge challenge. The aim of this meta-analysis was to compare the association of body mass index (BMI), which is an index of general obesity, and waist-to-height ratio (WHtR), an index of abdominal obesity, with cardiometabolic risk in cross-sectional and prospective studies.

METHODS

PubMed and Embase databases were searched for cross-sectional or prospective studies that evaluated the association of both BMI and WHtR with several cardiometabolic outcomes. The strength of relative risk (RR) with 95% confidence interval (CI) was calculated using the optimal cutoffs of BMI and WHtR in cross-sectional studies, while any available cutoff was used in prospective studies. The pooled estimate of the ratio of RRs (rRR [=RRBMI/RRWHtR]) with 95% CIs was used to compare the association of WHtR and BMI with cardiometabolic risk. Meta-regression was used to identify possible sources of heterogeneity between the studies.

RESULTS

Twenty-four cross-sectional studies and ten prospective studies with a total number of 512,809 participants were identified as suitable for the purpose of this meta-analysis. WHtR was found to have a stronger association than BMI with diabetes mellitus (rRR: 0.71, 95% CI: 0.59-0.84) and metabolic syndrome (rRR: 0.92, 95% CI: 0.89-0.96) in cross-sectional studies. Also in prospective studies, WHtR appears to be superior to BMI in detecting several outcomes, including incident cardiovascular disease, cardiovascular disease mortality, and all-cause mortality. The usefulness of WHtR appears to be better in Asian than in non-Asian populations. BMI was not superior to WHtR in any of the outcomes that were evaluated. However, the results of the utilized approach should be interpreted cautiously because of a substantial heterogeneity between the results of the studies. Meta-regression analysis was performed to explain this heterogeneity, but none of the evaluated factors, ie, sex, origin (Asians, non-Asians), and optimal BMI or WHtR cutoffs were significantly related with rRR.

CONCLUSION

The results of this meta-analysis support the use of WHtR in identifying adults at increased cardiometabolic risk. However, further evidence is warranted because of a substantial heterogeneity between the studies.

Over time, do anthropometric measures still predict diabetes incidence in chinese han nationality population from chengdu community?

Objective. To examine whether anthropometric measures could predict diabetes incidence in a Chinese population during a 15-year follow-up. Design and Methods. The data were collected in 1992 and then again in 2007 from the same group of 687 individuals. Waist circumference, body mass index, waist to hip ratio, and waist to height ratio were collected based on a standard protocol. To assess the effects of baseline anthropometric measures on the new onset of diabetes, Cox's proportional hazards regression models were used to estimate the hazard ratios of them, and the discriminatory power of anthropometric measures for diabetes was assessed by the area under the receiver operating curve (AROC). Results. Seventy-four individuals were diagnosed with diabetes during a 15-year follow-up period (incidence: 10.8%). These anthropometric measures also predicted future diabetes during a long follow-up (P < 0.001). At 7-8 years, the AROC of central obesity measures (WC, WHpR, WHtR) were higher than that of general obesity measures (BMI) (P < 0.05). But, there were no significant differences among the four anthropometric measurements at 15 years. Conclusions. These anthropometric measures could still predict diabetes with a long time follow-up. However, the validity of anthropometric measures to predict incident diabetes may change with time.

Comparisons of the strength of associations with future type 2 diabetes risk among anthropometric obesity indicators, including waist-to-height ratio: a meta-analysis

The aim of this meta-analysis was to compare the association of waist-to-height ratio (WHtR) with risk of incident diabetes with the associations of 3 other conventional obesity indicators (body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR)) with risk of incident diabetes. Literature searches in MEDLINE (January 1950 to April 27, 2011) and EMBASE (January 1974 to April 27, 2011) were conducted for prospective studies that made it possible to estimate the relative risk of diabetes per 1-standard deviation increase in WHtR, in addition to the RR of BMI, WC, or WHR. Strength of the estimated pooled relative risk for a 1-standard deviation increase of each indicator (expressed as RR(WHtR), RR(BMI), RR(WC), and RR(WHR)) was compared with a bivariate random-effects model. Pooled relative risks of the 15 eligible studies with 6,472 diabetes cases were 1.62 (95% CI: 1.48, 1.78) for RR(WHtR), 1.55 (95% CI: 1.43, 1.69) for RR(BMI), 1.63 (95% CI: 1.49, 1.79) for RR(WC), and 1.52 (95% CI: 1.40, 1.66) for RR(WHR). WHtR had an association stronger than that of BMI (P<0.001) or WHR (P<0.001). The present meta-analysis showed that WHtR has a modestly but statistically greater importance than BMI and WHR in prediction of diabetes. Nevertheless, measuring height in addition to WC appeared to have no additional benefit.

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.

Anthropometric indexes of obesity and hypertension in elderly from Cuba and Barbados

OBJECTIVE

To investigate the association between various anthropometric indexes of obesity with arterial hypertension in elderly from Barbados (Bridgetown) and Cuba (Havana).

DESIGN

Cross-sectional data were extracted from the Survey on Health, Aging and Well being in Latin America and the Caribbean (SABE).

SAMPLE SIZE

In Bridgetown and Havana, respectively, 1508 and 1905 subjects ( ≥ 60 years) were examined, and were selected by a controlled sampling design.

MEASUREMENTS

The occurrence of hypertension was assessed by self-report. Multiple measurements of adiposity were used including body mass index (BMI ≥ 28 kg/m(2)), waist hip ratio (WHR = > 0.95 men; > 0.80 women), waist to height ratio (W/ht. = > 0.50) and waist circumference - WC(L) ( > 88 cm, women; > 102 cm, men) e WC(OK) ( > 90.3 cm, women; > 91.3 cm, men). Binary logistic regression analyses (Odds Ratio) were used to measure strengths of relationships.

RESULTS

In the elderly of Bridgetown, the final design (adjusted for age, education, race, smoking, regular physical activity and diabetes) shows that, in men, WC(OK) and W/Ht were associated with hypertension, and in women, WCL and WCOK were the indexes associated. In the Cuban elderly, the final design shows that, with the exception of WHR, all indicators were associated with hypertension. WCOK and W/ht were the indexes most strongly associated with the outcome.

CONCLUSION

The explanatory power of anthropometric indicators when determining the outcome differed between men and women, as well as between cultural groups living in relative proximity (Barbadians and Cubans).

A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·5 could be a suitable global boundary value

This systematic review collated seventy-eight studies exploring waist-to-height ratio (WHtR) and waist circumference (WC) or BMI as predictors of diabetes and CVD, published in English between 1950 and 2008. Twenty-two prospective analyses showed that WHtR and WC were significant predictors of these cardiometabolic outcomes more often than BMI, with similar OR, sometimes being significant predictors after adjustment for BMI. Observations from cross-sectional analyses, forty-four in adults, thirteen in children, supported these predictions. Receiver operator characteristic (ROC) analysis revealed mean area under ROC (AUROC) values of 0·704, 0·693 and 0·671 for WHtR, WC and BMI, respectively. Mean boundary values for WHtR, covering all cardiometabolic outcomes, from studies in fourteen different countries and including Caucasian, Asian and Central American subjects, were 0·50 for men and 0·50 for women. WHtR and WC are therefore similar predictors of diabetes and CVD, both being stronger than, and independent of, BMI. To make firmer statistical comparison, a meta-analysis is required. The AUROC analyses indicate that WHtR may be a more useful global clinical screening tool than WC, with a weighted mean boundary value of 0·5, supporting the simple public health message 'keep your waist circumference to less than half your height'.

Is the association of type II diabetes with waist circumference or waist-to-hip ratio stronger than that with body mass index?

In total, 17 prospective and 35 cross-sectional studies in adults aged 18-74 years, with the aim of comparing betweenbody mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) in their relation to the incidence and prevalence of type II diabetes, were reviewed. Among these studies, only a few have used C-statistic, paired homogeneity test or log-likelihood ratio test for formally comparing the differences. Five prospective studies, in which formal statistic tests have been made, came out with inconsistent findings: two results were in favour of WC in Mexicans African Americanss, respectively, one result was in favour of BMI in Pima Indians, and no difference was found in the other 2 studies. Among the 11 cross-sectional studies that have formally tested the differences, most found a higher odds ratio or slightly larger area under the ROC curve (AUC) for WC than for BMI. A meta-analysis based on the individual data of the Asian cohorts using a paired homogeneity test showed, however, that there was no difference in odds ratio between BMI and WC in Chinese, Japanese, Indian, Mongolian and Filipino men. In conclusion, all studies included in this review showed that either BMI or WC (WHR) predicted or was associated with type II diabetes independently, regardless of the controversial findings on which of these obesity indicators is better.