Temporal trends in normal weight central obesity and its associations with cardiometabolic risk among Chinese adults.
Scientific reports
Normal weight central obesity (NWCO), a distinct phenotype of obesity that is associated with a higher risk of cardiometabolic dysregulation, has received growing attention in the scientific literature. In this study, we aimed to report the prevalence of NWCO in the general Chinese adults and its secular trend from 1993 to 2011. The comorbid cardiometabolic risk of NWCO was also explored. Data from the China Health and Nutrition Survey (CHNS) 1993-2011 were obtained. NWCO was defined as the combination of a BMI of 18.5-23.9 kg/m and 1) a waist circumference (WC) of >85 cm in males or >80 cm in females (NWCO by WC); 2) a waist to height ratio (WHtR) of ≥0.5 (NWCO by WHtR); 3) a waist to hip ratio (WHR) of ≥0.9 in males or ≥0.85 in females (NWCO by WHR). We assessed the trend of NWCO prevalence with the generalized estimating equation method. The demographic, socioeconomic, geographic, behavioural and cardiometabolic predictors of NWCO were explored with multivariable logistic regression. From 1993 to 2011, the age-standardized prevalence of NWCO by WC increased from 6.65% (95% CI: 6.09-7.26) to 13.24% (95% CI: 12.58-13.93), and that of NWCO by WHtR and NWCO by WHR rose from 13.18% (95% CI: 12.41-13.98) to 17.06% (95% CI: 16.35-17.79) and from 16.14% (95% CI: 15.3-17.01) to 19.04% (95% CI: 18.25-19.85) respectively. The associated cardiometabolic factors of NWCO (by WC, WHtR and WHR) were hypertension, diabetes, insulin resistance, decreased insulin sensitivity, low high-density lipoprotein and elevated triglyceride. Moreover, NWCO by WC and NWCO by WHtR were associated with a decreased risk of impaired insulin secretion, and NWCO by WC was additionally linked to elevated total cholesterol. The prevalence of NWCO in the general Chinese adults increased significantly from 1993 to 2011. Effective strategies are needed to combat this epidemic and reduce its deleterious health outcomes.
10.1038/s41598-019-41986-5
[A four-year prospective study of the relationship between body mass index and waist circumstances and hypertension in Chinese adults].
Li Yuan,Zhai Fengying,Wang Huijun,Wang Zhihong
Wei sheng yan jiu = Journal of hygiene research
OBJECTIVE:To explore whether the increase of body mass index (BMI) and waist circumstances (WC) can predict the higher risk of hypertension in Chinese adults. METHODS:The data were collected in the China Health and Nutrition Survey (CHNS). A total of 4552 adults aged 18-60 years old were selected as the subjects who were healthy in the baseline survey in 2000 and followed up in 2004. Logistic regression models were used to estimate the relative risk (RR) of developing hypertension associated with the BMI and WC in baseline and the four-year change of BMI and WC. RESULTS:The incidence of hypertension of men and women was 20.01% and 13.52% respectively during the four years of follow-up. The risk of developing hypertension rose with the increase of either BMI or WC in baseline. Compared with the group of neither general obesity (defined by BMI) nor abdominal obesity (defined by WC) group with both general obesity and abdominal obesity had the highest risk (men RR = 2.840, 95% CI: 2.139-3.771, women RR = 2.734, 95% CI: 2.050-3.647) among the different combinations of BMI and WC. Adjusted for other factors the risk of developing hypertension also increased with the four-year augment of either BMI or WC (BMI: men, RR = 1.141, 95% CI: 1.087-1.199, women, RR = 1.109, 95% CI: 1.056-1.164, WC: men, RR = 1.038, 95% CI: 1.022-1.055, women, RR = 1.035, 95% CI: 1.018-1.052). CONCLUSION:The increase of BMI and WC can predict the higher risk of the development of hypertension. The combination of BMI and WC can increase the predictive efficacy of the incidence of hypertension.
[Mediating effect of adulthood BMI/waist circumference on correlation between juvenile BMI/waist circumference and adulthood blood pressure].
Wei sheng yan jiu = Journal of hygiene research
OBJECTIVE:To analyze the relationship between juvenile body mass index(BMI)/waist circumference(WC) and adult blood pressure(BP), and to further explore the mediating role of adult BMI/WC in this association. METHODS:Based on the data of China Health and Nutrition Survey(CHNS) from 1993 to 2015, 1313 subjects were selected, who participated in the survey both in juvenile(6-17 years old) and adult(18-35 years old). The mediating effect model was used to analyze the effect of adult BMI/WC in the association between juvenile BMI/WC and adult BP. RESULTS:There was a positive correlation between juvenile BMI/WC and adult systolic blood pressure [β(SE)_(adjusted)=0.10(0.03)/0.08(0.03)] and diastolic blood pressure [β(SE)_(adjusted)=0.13(0.03)/0.08(0.03)] with P <0.01. Adult BMI/WC played partial mediating effect in the association between juvenile BMI/WC and adult systolic blood pressure and diastolic blood pressure: the percentage of mediating effect of BMI were 70.00%(95%CI 42.68%-73.33%)for SBP and 23.08%(95%CI 14.29%-26.32%) for DBP, the percentage of mediating effect of WC were 37.50%(95%CI 20.00%-41.67%)for SBP and 25.00%(95%CI 20.00%-35.71%) for DBP, respectively. CONCLUSION:There is a positive correlation between juvenile BMI/WC and adult BP, and adult BMI/WC might mediate the effect of juvenile BMI and WC on adult BP.
10.19813/j.cnki.weishengyanjiu.2022.03.013
Association between Visceral Adiposity Index and hypertension among Chinese Adults: a nationwide cross-sectional study in the China Health and Nutrition Survey.
Yang Jing,Li Hongxia,Han Lianhua,Zhang Lei,Zhou Yafeng
Blood pressure monitoring
BACKGROUND:Visceral Adiposity Index (VAI) is an indicator of visceral adipose function. It showed an intense association with cardiometabolic risks, but it is unclear whether VAI is associated with hypertension. OBJECTIVE:We aim to determine the association of VAI with hypertension in Chinese adults. METHODS:We carried out a cross-sectional analysis of 5421 Chinese adults based on data which was from the China Health and Nutrition Survey (CHNS) 2009. Multivariable logistic regression and linear regression were performed to confirm the association. RESULTS:In multivariable logistic regression analysis, there was a dose-response association between VAI and the risk of incident hypertension (P for trend <0.01). The sex and age-adjusted odds ratios (ORs) [95% confidence interval (CI)] for the development of hypertension were 1.06 (0.90-1.26) in the second, 1.09 (0.92-1.29) in the third, and 1.28 (1.08-1.52) in the fourth VAI quartile, compared to the first quartile. The multivariable linear regression analysis indicated that VAI was positive association with systolic blood pressure (β = 0.37; 95% CI, 0.13-0.62; P = 0.0028) and diastolic blood pressure (β = 0.26; 95% CI, 0.12-0.40; P = 0.0004). The subgroup analysis showed that VAI had more positive association with hypertension in participants with an apolipoprotein A1 of ≥1.2 g/L (P = 0.0115) or a hemoglobin A1c of ≥6.5% (P = 0.0369). CONCLUSIONS:VAI was positively associated with hypertension among the Chinese adult population, and it may assume an indicator of hypertension risk for the Chinese population.
10.1097/MBP.0000000000000469
A novel quantitative body shape score for detecting association between obesity and hypertension in China.
Wang Shukang,Liu Yanxun,Li Fangyu,Jia Hongying,Liu Longjian,Xue Fuzhong
BMC public health
BACKGROUND:Obesity is a major independent risk factor for chronic diseases such as hypertension and coronary diseases, it might not be only related to the amount of body fat but its distribution. The single body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) or waist to stature ratio (WSR) provides limited information on fat distribution, and the debate about which one is the best remained. On the other hand, the current classification of body shape is qualitative rather than quantitative, and only crudely measure fat distribution. Therefore, a synthetical index is highly desirable to quantify body shape. METHODS:Based on the China Health and Nutrition Survey (CHNS) data, using Lohmäller PLSPM algorithm, six Partial Least Squares Path Models (PLSPMs) between the different obesity measurements and hypertension as well as two synthetical body shape scores (BSS1 by BMI/WC/Hip circumference, BSS2 by BMI/WC/WHR/WSR) were created. Simulation and real data analysis were conducted to assess their performance. RESULTS:Statistical simulation showed the proposed model was stable and powerful. Totally 15,172 (6,939 male and 8,233 female) participants aged from 18 to 87 years old were included. It indicated that age, height, weight, WC, WHR, WSR, SBP, DBP, the prevalence of hypertension and obesity were significantly sex-different. BMI, WC, WHR, WSR, Hip, BSS1 and BSS2 between hypertension and normotensive group are significantly different (p < 0.05). PLSPM method illustrated the biggest path coefficients (95% confidence interval, CI) were 0.220(0.196, 0.244) for male and 0.205(0.182, 0.228) for female in model of BSS1. The area under receiver-operating characteristic curve (AUC(95% CI)) of BSS1(0.839(0.831,0.847)) was significantly larger than that of BSS2(0.834(0.825,0.842)) as well as the four single indices for female, and similar trend can be found for male. CONCLUSIONS:BSS1 was an excellent measurement for quantifying body shape and detecting the association between body shape and hypertension.
10.1186/s12889-014-1334-5
Joint effects of age and body mass index on the incidence of hypertension subtypes in the China Health and Nutrition Survey: A cohort study over 22years.
Qi Su-Fen,Zhang Bing,Wang Hui-Jun,Yan Jing,Du Pei,Zhang Wei,Mi Ying-Jun,Zhao Jing-Jing,Liu Dian-Wu,Tian Qing-Bao
Preventive medicine
OBJECTIVES:We seek to investigate the joint effects of age and body mass index (BMI) on the incident hypertension subtypes among Chinese adults during 1989-2011. METHODS:We investigated the Incidence rates (IRs, per 100person-years) of hypertension subtypes, adjusted relative risks (RRs) and population attributable risk percent (PAR%) of BMI for hypertension, and clarified the age-specific effect of BMI on incident hypertension utilizing a dynamic cohort study from the China Health and Nutrition Survey (CHNS) 1989-2011. RESULTS:Normotensive participants (n=53,028) at baseline were included, with mean age was 41.7 (95% CI, 41.6-41.7)years old. During a total of 118,694person years (average was 6.38years) of follow-up, a total of 5208 incident cases of hypertension were documented. The IRs of hypertension were 4.4 (95% CI, 4.3-4.5), which increased gradually by age and BMI (Ptrend<0.001). Compared with those with BMI<22kg/m(2), the RR of hypertension was 3.13 (95% CI, 2.84-3.45) in the group with BMI≥28kg/m(2). The PAR% (BMI>22 vs. BMI<22) for hypertension in Chinese population was 32% (95% CI, 29-34%). Similar trends were observed in all age and BMI groups for both isolated systolic hypertension and systolic-diastolic hypertension, which were mainly affected by age. In contrast, the peak IR of isolated diastolic hypertension was observed in participants aged 30-49years with higher BMIs. CONCLUSIONS:The PAR% (IR of BP≥140/90 or treatment for BMI>22 vs. IR for BMI<22) of elevated body weight for hypertension was 32% in Chinese population.
10.1016/j.ypmed.2016.05.004
The comparison of percent body fat estimated by different anthropometrics to predict the incidence of hypertension.
Chen Yongjie,Liang Xuan,Zheng Senshuang,Wang Yuan,Lu Wenli
Journal of human hypertension
Percent body fat (%BF) is associated with the development of hypertension. However, the power of %BF estimated by different anthropometrics to predict incident hypertension was unknown. This study was from the China Health and Nutrition Survey (CHNS). %BF was calculated using the equations with BMI, WC, and skinfold thickness and divided into low and high %BF according to ROC. Cox regression was employed to evaluate the power of different %BFs to predict the development of hypertension. When not adjusting for covariates, %BFs defined by BMI, WC, and ST were the significant predictors of the development of hypertension (all P < 0.0001; crude HR: 2.238, 3.243, and 1.574; and HR 95% CI: 2.098-2.387, 2.905-3.619, and 1.464-1.692). When three %BFs entered into model simultaneously, the significance in %BF estimated by ST disappeared (P = 0.0765; adjusted HR: 1.124; and HR 95% CI: 0.988-1.280). For males, %BFs by BMI, WC, and ST significantly affected the incidence of hypertension as they were separately analyzed (all P < 0.0001; crude HR: 2.445, 2.335, and 1.828; and HR 95% CI: 2.220-2.693, 2.011-2.712, and 1.636-2.042, respectively). For females, %BFs estimated by BMI, WC, and ST were the determinants of the development of hypertension whether covariates were adjusted or not (all P < 0.0001). In conclusion, there was a poor and ineffective association of %BF estimated by triceps skinfold thickness with the development of hypertension, especially when three %BFs were analyzed together. High %BFs estimated by BMI and WC were the true and effective predictors of the incidence of hypertension.
10.1038/s41371-019-0240-9
Long-term body mass trajectories and hypertension by sex among Chinese adults: a 24-year open cohort study.
Scientific reports
Evidence was limited on trajectory of body mass index (BMI) through adulthood and its association with hypertension. We aimed to evaluate their association by sex in large-scale study. Data were obtained from the China Health and Nutrition Survey (CHNS) from 1991 to 2015. Latent class trajectory analysis (LCTA) was used to capture BMI change trajectories. Hazard risks (HRs) were estimated from Cox proportion hazard regression. Among 14,262 participants (mean age, 38.8; 47.8% men), 5138 hypertension occurred (2687 men and 2451 women) occurred during a mean follow-up 9.6 years. Four body mass trajectory groups were identified as BMI loss, stable, moderate and substantial gain. Appropriately half of participants (48.0%) followed 1 of the 2 BMI gain trajectories, where BMI increased at least 3 kg/m overtime. Compared with participants with stable BMI, those gaining BMI substantially had higher risk of hypertension by 65% (HR 1.65, 95% CI 1.45-1.86) in male and 83% (HR 1.83, 95% CI 1.58-2.12) in female. The HRs in BMI loss patterns were 0.74 (0.62-0.89) in men and 0.87 (0.75-1.00) in women. Our findings imply that majority of Chinese adults transited up to a higher BMI level during follow-up. Avoiding excessive weight gain and maintaining stable weight might be important for hypertension prevention.
10.1038/s41598-021-92319-4
Waist Circumference Trajectories in Relation to Blood Pressure and the Risk of Hypertension in Chinese Adults.
Nutrients
Central obesity is associated with a higher risk of hypertension. This study aimed to analyze waist circumference (WC) trajectories and discover their association with blood pressure and the risk of hypertension. The data were obtained from the China Health and Nutrition Survey (CHNS), with a sample of 11,885 adults aged 18 or older. Trajectory groups of WC were identified by group-based trajectory modeling. Three trajectory groups were identified in males: "normal-stable group" (group 1), "normal-increase to central obesity group" (group 2), and "central obesity-slight decrease group" (group 3). There were also three identified in females: "normal-increase to central obesity group" (group 1), "normal-stable group" (group 2), and "central obesity-increase group" (group 3). For males, compared with group 1, systolic blood pressure (SBP) and diastolic blood pressure (DBP) increased by 2.47 mmHg and 2.13 mmHg, respectively, in group 2, and by 3.07 mmHg and 2.54 mmHg, respectively, in group 3. The adjusted hazard ratios (HR) and 95% confidence interval (95% CI) of hypertension in groups 2 and 3 were 1.16 (1.06-1.28) and 1.29 (1.10-1.50), respectively. For females, compared with group 2, SBP and DBP increased by 1.69 mmHg and 1.68 mmHg, respectively, in group 1, and by 4.96 mmHg and 2.77 mmHg, respectively, in group 3. The HR and 95% CI of hypertension in groups 2 and 3 were 1.21 (1.07-1.36) and 1.52(1.17-1.99), respectively. We found that the WC trajectory was a risk factor for hypertension and elevated blood pressure independent of basal WC. Increased risk of hypertension was nonlinearly associated with annual WC increase.
10.3390/nu14245260
Development and validation of a model to predict the risk of hypertension using anthropometric indicators in the Chinese population: a retrospective cohort study.
American journal of translational research
BACKGROUND:The prevalence of hypertension and obesity in China has sharply increased in recent decades. We aimed to develop and validate a novel model for predicting the risk of hypertension based on anthropometric indicators relating to obesity in the general population of China. METHODS:In this retrospective study, 6196 participants from the China Health and Nutrition Survey (CHNS) during the 2009-2015 waves were included. Risk factors for hypertension were assessed by LASSO regression combined with multivariate logistic regression analysis. A nomogram was developed as a predictive model based on the screening prediction factors. The discrimination and calibration of the model were evaluated by receiver operating curve (ROC) and calibration plots, respectively. Decision curve analysis (DCA) was used to evaluate the clinical application value of the model. RESULTS:A total of 6196 participants were divided into two sets at a ratio of 7:3, using computer-generated random numbers: 4337 individuals were assigned to the training set and 1859 to the validation set. The training set was divided into a hypertension group (n = 1016) and a non-hypertension group (n = 3321) based on the follow-up outcomes for hypertension. Predictive factors of hypertension included age, drinking, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and arm-to-height ratio (AHtR) at baseline as predictors. The area under the ROC curve (AUC) for the training and validation sets was 0.906 (95% CI: 0.897-0.915) and 0.905 (95% CI: 0.887-0.922), respectively. In bootstrap validation, the C-index was 0.905 (95% CI: 0.888-0.921). The model also had good predictive accuracy according to the calibration plot. DCA demonstrated that people would benefit more when the threshold probability was between 5% and 80%. CONCLUSION:A nomogram model was successfully established to effectively predict the risk of hypertension based on anthropometric indicators. The model could be a feasible tool for hypertension screening in the general population of China.
Transportation physical activity and new-onset hypertension: A nationwide cohort study in China.
Hypertension research : official journal of the Japanese Society of Hypertension
The association between transportation physical activity (PA) and the risk of hypertension remains uncertain. We aimed to evaluated the prospective relation of transportation PA and new-onset hypertension among Chinese adults. A total of 9350 adults who were free of hypertension at baseline were enrolled from the China Health and Nutrition Survey (CHNS). Data on transportation PA were obtained by using self-reported questionnaires, and calculated as metabolic equivalent task (MET)-minutes/week. MET-minutes/week may account for both intensity and time spent on activities. The study outcome was new-onset hypertension, defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg or diagnosed by physician or under antihypertensive treatment during the follow-up. During a median of 8.0 years (82,410 person-years) of follow-up, a total of 2949 participants developed hypertension. Overall, there was a U-shaped association between transportation PA and new-onset hypertension (P values for nonlinearity <0.001). Accordingly, compared with those with moderate transportation PA (213-<394 MET-minutes/week, the second quartile), significantly higher risks of new-onset hypertension were observed not only in participants with transportation PA < 213 MET-minutes/week (the first quartile) (HR, 1.29; 95%CI: 1.15-1.44), but in those with transportation PA ≥ 394 MET-minutes/ week (the 3-4 quartiles) (HR, 1.15; 95%CI: 1.04-1.27). Similar U-shaped correlations were found for various types of transportation PA (walking, bicycling, and motorized PA) and new-onset hypertension. In summary, moderate transportation PA is associated with a lower risk of new-onset hypertension among Chinese adults.
10.1038/s41440-022-00973-6
The Visceral Adipose Index in Relation to Incidence of Hypertension in Chinese Adults: China Health and Nutrition Survey (CHNS).
Xue Yong,Shen Qun,Li Chang,Dai Zijian,He Tingchao
Nutrients
Hypertension is the most crucial single contributor to global burden of disease and mortality, while weight loss as a non-pharmacological strategy is recommended to reduce blood pressure. This study aims to examine the association between visceral adipose index (VAI) and hypertension in Chinese adults. Data were collected from the China Health and Nutrition Survey (CHNS), consisting of 8374 apparently healthy participants aged ≥18 years in the 2009 CHNS for cross-sectional analysis, and 4275 participants at entry from 2009 to 2011 for cohort analysis. Height, weight, waist circumference, blood pressure (BP), and blood lipid were measured. Information of population characteristics, smoking status, alcohol consumption, physical activity, and diet were determined by validated questionnaire. Higher VAI scores were significantly associated with higher BP levels and higher risk of hypertension after adjustment with potential confounders (all -trend < 0.001). The adjusted hazard ratio of hypertension was 1.526 (95%CI: 1.194, 1.952; -trend < 0.01) for participants in the highest quartile of VAI scores when compared with those in the lowest quartile after adjustment for age, physical activity, antihypertensive medication, total energy intake, salt intake, and other major lifestyle factors. VAI scores were significantly, longitudinally associated with hypertension development among apparently healthy Chinese adults.
10.3390/nu12030805
There was a similar U-shaped nonlinear association between waist-to-height ratio and the risk of new-onset hypertension: findings from the CHNS.
Frontiers in nutrition
Background:The association between waist-to-height ratio (WHtR) with hypertension has not been adequately explained, so in this study we sought to clarify the predictive role of WHtR on the incidence of hypertension as well as the potential nonlinear associations in the general population. Methods:In this large prospective cohort study, a total of 4,458 individuals from the China Health and Nutrition Survey (CHNS) were included in the analysis. Multivariate Cox regression analyses, subgroup analyses, receiver operator characteristic (ROC) and restricted cubic spline (RCS) analyses were used to examine the association of WHtR with the risk of new-onset hypertension. Results:Hypertension occurred in 32.8% of participants during the maximum six-year follow-up period. Compared with the group with lower WHtR, the group with higher WHtR had a higher incidence of hypertension ( < 0.001). Multivariate Cox regression analysis showed that the risk of hypertension was 1.45 times higher in the high WHtR group than in the low WHtR group, and that the risk of hypertension increased by 30.4% for every 0.1 unit increase in WHtR ( < 0.001). Subgroup analyses also validated the stratified associations between WHtR and the risk of new-onset hypertension in most subgroups ( < 0.05). ROC analyses also revealed that WHtR was superior to body mass index in predicting new-onset hypertension (AUC: 0.626 vs. 0.607, = 0.009). Further RCS analysis detected a nonlinear association between WHtR and risk of new-onset hypertension (P for nonlinearity <0.001). Conclusion:WHtR was nonlinearly associated with the risk of new-onset hypertension in the general population.
10.3389/fnut.2023.1304521