Obesity-related hypertension: Findings from The Korea National Health and Nutrition Examination Survey 2008-2010

Risk of sleep apnea associated with higher blood pressure among Chinese and Korean Americans

OBJECTIVE

This study examines associations between sleep apnea risk and hypertension in a sample of immigrant Chinese and Korean Americans.

DESIGN

The dataset included Chinese and Korean patients ages 50-75 recruited from primary care physicians' offices from April 2018 to June 2020 in the Baltimore-Washington DC Metropolitan Area (n = 394). Hypertension risk was determined using a combination of blood pressure measurements, self-reported diagnosis of hypertension by a medical professional, and/or self-reported use of antihypertensive medications. Linear regression models examined the associations between sleep apnea risk and blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). Poisson regression models examined associations sleep apnea risk and hypertension. Models controlled for body mass index (BMI), demographic, and socioeconomic risk factors. We further examined models for potential effect modification by age, gender, Asian subgroup, and obesity, as well as effect modification of daytime sleepiness on the association between snoring and hypertension risk.

RESULTS

High risk of sleep apnea appeared to be associated positively with SBP (β = 6.77, 95% CI: 0.00-13.53), but not with DBP. The association was positive for hypertension, but it was not statistically significant (PR = 1.11, 95% CI: 0.87-1.41). We did not find effect modification of the associations between sleep apnea and hypertension risk, but we did find that daytime sleepiness moderated the effect of snoring on SBP. Snoring was associated with higher SBP, primarily in the presence of daytime sleepiness, such that predicted SBP was 133.27 mmHg (95% CI: 126.52, 140.02) for someone with both snoring and daytime sleepiness, compared to 123.37 mmHg (95% CI: 120.40, 126.34) for someone neither snoring nor daytime sleepiness.

CONCLUSION

Chinese and Korean immigrants living in the U.S. who are at high risk of sleep apnea have higher SBP on average, even after accounting for sociodemographic characteristics and BMI.

CLINICAL TRAIL REGISTRATION

: NCT03481296, date of registration: 3/29/2018.

Association Between High Blood Folate Levels and Glaucoma in a Representative Korean Population

Purpose

This study aimed to investigate the association between folate levels and the prevalence of glaucoma.

Methods

This nationwide population-based cross-sectional study included 1790 participants aged ≥40 years. We analyzed data regarding the participants obtained in the 2016-2018 Korean National Health and Nutrition Examination Survey. The diagnosis of glaucoma was defined according to the International Society of Geographical and Epidemiological Ophthalmology criteria. Logistic regression analyses were used to investigate the relationship between blood folate levels and glaucoma.

Results

There was a significantly lower prevalence of glaucoma in the highest quartile of blood folate levels than in the lowest quartile, after adjusting for confounding factors such as age, sex, systemic hypertension, diabetes, hypercholesterolemia, and smoking (odds ratio [OR] = 0.470; 95% confidence interval [CI], 0.291-0.759; P for trend = 0.017). There was a significantly lower risk of glaucoma in the highest quartile of blood folate levels than in the lowest quartile among women (OR = 0.188; 95% CI, 0.099-0.357; P for trend <0.001) and younger participants (OR =0.443; 95% CI, 0.229-0.856; P for trend = 0.045).

Conclusions

Our findings indicate a strong inverse correlation between blood folate levels and glaucoma.

Are ambulatory blood pressure parameters associated more with central adiposity than with total adiposity? Results of the ELSA-Brasil study

Background

Worldwide obesity has a high prevalence, as well as carries a high risk of several chronic diseases, including hypertension. Studies of the association between obesity and ambulatory blood pressure (BP) are scarce and most use only body mass index (BMI) as indicator of adiposity. Thus, we aimed to examine for associations between total and central adiposity and ambulatory BP parameters (BP means and variability, nocturnal dipping and morning surge) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

This cross-sectional study (2012-2014) used a subsample of participants (n = 812) of ELSA-Brasil who underwent 24-hour ambulatory BP monitoring to assess systolic and diastolic BP (SBP and DBP, respectively) over 24-hour periods and sub-periods. Indicators for total adiposity were BMI and body fat (BF) and, for central adiposity, waist circumference (WC) and waist-to-height ratio (WHR). Associations were tested using crude and adjusted gamma and logistic regression.

Results

Overweight (BMI) and abdominal obesity (WC and WHR) associated positively with mean 24-hour (Coef = 2.71, 3.09 and 4.00, respectively), waking (Coef = 2.87, 3.26 and 4.16, respectively), and sleeping (Coef = 2.30, 2.74 and 3.50, respectively) SBP; mean DBP associated with high WHR in these three periods (Coef = 2.00, 2.10 and 1.68, respectively) and with WC in the waking period (Coef = 1.44). Overweight and abdominal obesity (WC and WHR) were positively associated with SBP variability over 24 h (Coef = 0.53, 0.45 and 0.49, respectively) and in sleep (Coef = 0.80, 0.74 and 0.59, respectively), and with DBP variability in 24 h (Coef = 0.64, 0.73 and 0.58, respectively), wakefulness (Coef = 0.50, 0.52 and 0.52, respectively) and sleep (Coef = 0.53, 0.45 and 0.49); excess BF associated positively with DBP variability over 24 h (Coef = 0.43) and in wakefulness (Coef = 0.38). Lastly, high WHR and excess BF were associated with higher odds of extreme dipping (OR = 1.03 for both), while high WC and WHR associated with higher odds of exacerbated diastolic morning surge (OR = 3.18 and 3.66, respectively).

Conclusion

Indicators of adiposity were associated with the BP means and variability, nocturnal dipping and morning surge, with more substantial results for indicators of central adiposity that the others.

The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesity

Loss of physiological nocturnal blood pressure (BP) decline is an independent predictor of cardiovascular risk and mortality. The aim of the study was to investigate the influence of body composition and fat distribution on 24-hour BP pattern and nocturnal dipping of mean arterial pressure (MAP) in patients with obesity. The study comprised 436 patients, 18 to 65 years old (306 women), with BMI ≥30 kg/m2. Body composition was assessed with dual-energy X-ray absorptiometry (DXA) and blood pressure was assessed by 24-hour BP monitoring. The prevalence of hypertension was 64.5% in patients with BMI <40 kg/m2 and increased to 78.7% in individuals with BMI ≥50 kg/m2 (p = 0.034). The whole-body DXA scans showed that the hypertensive patients were characterized by a greater lean body mass (LBM) and a higher abdominal-fat-to-total-fat-mass ratio (AbdF/FM), while the normotensive participants had greater fat mass, higher body fat percentage and more peripheral fat. Loss of physiological nocturnal MAP decline was diagnosed in 50.2% of the patients. The percentage of non-dippers increased significantly: from 38.2% in patients with BMI <40 kg/m2 to 50.3% in those with BMI 40.0-44.9 kg/m2, 59.0% in patients with BMI 45.0-49.9 kg/m2, 71.4% in those with BMI 50.0-54.9 kg/m2 and 83.3% in patients with BMI ≥55 kg/m2 (p = 0.032, p = 0.003, p<0.001, and p = 0.002 vs. BMI <40 kg/m2, respectively). The multivariable regression analysis showed that patients at the highest quartiles of body weight, BMI, LBM and AbdF/FM had significantly reduced nocturnal MAP dipping compared with patients at the lowest quartiles, respectively.

Associations between novel anthropometric measures and the prevalence of hypertension among 45,853 adults: A cross-sectional study

AIMS

Traditional anthropometric measures, including body mass index (BMI), are insufficient for evaluating the risk of hypertension. We aimed to investigate the association between novel anthropometric indices and hypertension risk in a large population in the United States.

METHODS

Forty-five thousand eight hundred fifty-three participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were enrolled. Social demographic information, lifestyle factors, blood biochemical measurements and anthropometric indices, including body weight, body mass index (BMI), waist circumference, waist-to-height ratio (WtHR), conicity index (CI), a body shape index (ABSI), body roundness index (BRI) and lipid accumulation product (LAP) were collected. Multivariable logistic regression and restricted cubic spline were adopted to investigate the associations between hypertension risk and anthropometric indices. We also performed receiver operating characteristic (ROC) curve analyses to further evaluate the discriminatory powers of anthropometric measurements for screening hypertension risk. Moreover, participants were randomly assigned to the training group and the validation group in a ratio of 3 to 1. A nomogram model based on anthropometric measures was established and validated in the training group and validation group, respectively.

RESULTS

All of the anthropometric measurements investigated were positively and independently associated with the hypertension risk. Among all anthropometric indices, per-SD increment in ABSI had the highest OR (OR: 3.4; 95% CI: 2.73-4.24) after adjusting for age, sex, race/ethnicity, education, smoking, drinking, diabetes, and eGFR. Moreover, results from restricted cubic splines revealed the non-linear association between anthropometric measurements and hypertension risk. In ROC analyses, CI had superior discriminatory power for hypertension (area under the curve: 0.71; 95% CI: 0.706-0.715; optimal cutoff value: 1.3) compared with other indices. Nomogram model based on age, sex, diabetes, CI and LAP showed favorable predicting ability of hypertension risk with an AUC (95% CI) in training group of 80.2% (79.7-80.6%), and the AUC (95% CI) in validation group was 79.5% (78.3-80.1%). Meanwhile, calibration plot showed good consistency.

CONCLUSIONS

Anthropometric measurements including BMI, WtHR, CI, ABSI, BRI and LAP are closely associated with hypertension risk in the present study. For better prevention and treatment of hypertension, more attention should be paid to anthropometric indices, especially novel anthropometric indices.

Nutrition, Body Composition, and Blood Pressure in Children and Adolescents from the Korea National Health and Nutrition Examination Survey

We aimed to investigate the association between nutrition and blood pressure and the role that body composition plays in this relationship. Korea National Health and Nutrition Examination Survey data from the years 2008-2020 were reviewed. A total of 11,234 subjects (5974 boys and 5260 girls) aged 10-18 years of age were selected. We analyzed the correlation between nutrition (intakes of energy, protein, fat, carbohydrate, sodium, saturated fatty acid (SFA), unsaturated fatty acid (USFA), and dietary fiber (DF)) and body composition (height, weight, waist circumference (WC), body mass index (BMI), and waist to height ratio (WHtR)), and performed multiple regression analysis to find the independent correlation between body composition and blood pressure (BP). We then compared the correlation between nutrition and BP, with or without adjustment for body composition. The intakes of energy, protein, fat, carbohydrate, sodium, and USFA had positive associations with height, weight, WC, and BMI. Systolic BP (SBP) and diastolic BP (DBP) were independently positively correlated with height and BMI. The intakes of energy, protein, fat, carbohydrate, sodium, and SFA had positive correlations with SBP and DBP, which disappeared when additionally adjusted for BMI and height. In conclusion, nutrition seems to affect BP via height and BMI in Korean children and adolescents.

Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants

Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.

The association of hypertriglyceridemic waist phenotype with hypertension: A cross-sectional study in a Chinese middle aged-old population

The present study aimed to evaluate the relationship between the hypertriglyceridemic waist (HTGW) phenotype and hypertension. We undertook a cross‐sectional study with a sample of 9015 adults from China. The HTGW phenotype was defined as elevated waist circumference (WC) and elevated triglyceride (TG) concentration. Logistic regression analysis was used to evaluate the association between the HTGW phenotype and hypertension. The prevalence of hypertension was significantly higher in individuals with the HTGW phenotype, than in those with the normal waist normal triglyceride (NWNT) phenotype (89.9% vs 75.3%, respectively, P < .001). After adjusting for age, sex, BMI, current smoker, and current alcohol consumption, the HTGW phenotype was associated with hypertension (Odds Ratio (OR)1.53; 95% CI 1.25–1.87). After further adjustment for potential confounders, the HTGW phenotype was still significantly associated with hypertension (adjusted OR1.28; 95% CI 1.04‐1.58) regardless of sex. The subgroup analyses generally revealed similar associations across all subgroups. This study indicated that the HTGW phenotype was strongly associated with hypertension, and blood pressure should be clinically monitored in individuals with the HTGW phenotype. We suggested a combined use of hypertriglyceridemia waist phenotype in identifying participants who are at high risk of hypertension.

Association Between Waist Circumference and the Prevalence of (Pre) Hypertension Among 27,894 US Adults

Aims: This study aimed to investigate the association between waist circumference and the prevalence of (pre) hypertension.

Methods: Cross-sectional data from the 2007–2018 National Health and Nutrition Examination Survey were analyzed. The historical trend of abdominal obesity was assessed by the Cochran–Armitage trend test. After preprocessed by the multiple imputation strategy, we used generalized additive models to assess the association of waist circumference with systolic/diastolic blood pressure and performed correlation analysis by the Spearman correlation coefficient. Moreover, we used multivariable logistic regression (non-adjusted, minimally adjusted, and fully adjusted models), restricted cubic spline, and sensitivity analysis to investigate the association between waist circumference and (pre) hypertension.

Results: A total of 27,894 participants were included in this study. In the fully adjusted model, waist circumference was positively associated with (pre) hypertension with odds ratios (95% confidence intervals) of 1.28 (1.18–1.40) in the young group and 1.23 (1.15–1.33) in the old group. Restricted cubic spline showed a higher prevalence of (pre) hypertension with the increase of waist circumference. In the subgroup analysis, waist circumference showed a robust trend across all BMI categories with odds ratios (95% confidence intervals) of 3.33 (1.29–8.85), 1.35 (1.17–1.57), 1.27 (1.13–1.41), and 1.09 (1.01–1.17) in underweight, normal weight, overweight, and obese individuals, respectively.

Conclusion: This study highlighted waist circumference as a significant biomarker to evaluate the risk of (pre) hypertension. Our results supported the measure of waist circumference regardless of BMI when evaluating the cardiometabolic risk related to fat distribution.

Gender Differences in Prevalence and Risk Factors for Hypertension among Adult Populations: A Cross-Sectional Study in Indonesia

Although hypertension is among the main public health concerns in Indonesia, due to the scarcity of data, few studies have investigated the factors associated with hypertension in men and women. This study aimed to examine the prevalence of and factors associated with hypertension among adult men and women in Indonesia. The 2018 Survey of the Sleman Health Demographic and Surveillance System was utilized, consisting of 4328 individuals aged 18+ years. Multivariable logistic regression analysis was performed to determine the sociodemographic and health behavior factors of hypertension. Overall, the prevalence of hypertension was 40% (42% in men and 38% in women). Age, abdominal obesity and chronic non-communicable diseases were the common predictors of hypertension in men and women (p < 0.05). The odds ratio of hypertension among men with low education was lower than among those with high education (OR = 0.52, 95% CI: 0.29–0.94). For women, being in the poorest socioeconomic condition increased the risk of hypertension by 1.67 times compared to the richest (95% CI: 1.21–2.32). Gender differences in the prevalence of and factors associated with hypertension were observed among adult populations in Sleman District, Yogyakarta, Indonesia. Therefore, a gender-based approach in the health prevention strategy to control hypertension for men and women is needed.

Contribution of Different Phenotypes of Obesity to Metabolic Abnormalities from a Cross-Sectional Study in the Northwest China

BACKGROUND

This study has been conducted to explore the correlation between phenotypes of obesity and metabolic comorbidities.

METHODS

This cross-sectional study recruited 14,724 adults aged ≥18 years with a randomized stratified sampling strategy. Obesity was classified into four types according to body mass index (BMI) and waist-to-height ratio (WHtR): normal weight with central obesity (NWCO) and without (NW) CO, and obese or overweight with (OBCO) and without (OB) central obesity. Uric acid (UA), fasting blood glucose (FBG), and lipid profile were measured.

RESULTS

The prevalence of hyperuricemia in the 4 groups (NW, NWCO, OB and OBCO) was 3.7%, 5.6%, 8.7% and 12.4%, whilst the prevalence of hypertriglyceridemia was 13.4%, 27.4%, 30.3% and 43.7%, separately. The prevalence of hypo-high-density lipoprotein cholesterolemia (hypo-HDL emia) was 20.1%, 21.4%, 30.8% and 27.9%, while the prevalence of hyper-low-density lipoprotein cholesterolemia (hyper-LDL emia) was 9.8%, 24.4%, 12.3% and 27.9%. The prevalence of hypercholesterolemia was 11.2%, 23.5%, 14.7%, 28.5% and the prevalence of hyperglycemia was 9.7%, 22.6%, 18.5%, and 27.0%, respectively. The prevalence of hypertension was 6.9%, 13.1%, 14.7%, and 20.6%. For various metabolic abnormalities, OBCO have the highest risks compared with NW (hyperuricemia: adjusted OR (aOR)= 2.60; hypertriglyceridemia: aOR= 3.19; hypercholesterolemia: aOR= 1.48; hyper LDLemia: aOR= 2.21; hypo HDLemia: aOR= 1.42; hyperglycemia: aOR= 1.95; hypertension: aOR= 2.16). The risk of hyper LDLemia, hypercholesterolemia and hyperglycemia in the NWCO group was higher than that in the OB group (hyperLDLemia: aOR: 1.69 vs 0.97; hypercholesterolemia: aOR: 1.27 vs 1.24; hyperglycemia: aOR: 1.62 vs 1.28).

CONCLUSION

Different phenotypes of obesity are significantly associated with metabolic abnormalities. NWCO is more closely associated with hypercholesterolemia, hyperglycemia and hyper LDLemia. General obesity and central obesity have a synergistic effect on the diseases.

Cardiometabolic risk and health behaviours in adolescents with normal-weight obesity: a systematic review

OBJECTIVE

To analyse the presence of cardiometabolic risk factors in adolescents with normal-weight obesity (NWO), as well as to investigate health behaviours related to the phenotype.

DESIGN

The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the bibliographic search was carried out in the PubMed, Scielo and ScienceDirect databases.

SETTING

School, university and population.

PARTICIPANTS

Adolescents between 10 and 19 years old.

RESULTS

A total of eight papers were included. Most studies have found a relationship between NWO and the presence of cardiometabolic risk factors, such as high waist circumference, unfavourable lipid and glycid profile. As for health behaviours, three of the eight studies included evaluated eating habits; however, the results were not conclusive. In addition, four studies analysed the practice of physical activity or physical fitness, which was lower in NWO.

CONCLUSIONS

The available evidence indicates that NWO is related to the early development of cardiometabolic changes, physical inactivity and less physical fitness in adolescents. The results also reveal the importance of early detection of the phenotype, as well as the need for further research on the associated factors to prevent future diseases. Registration (PROSPERO: CRD42020161204).