Associations of anthropometric adiposity indexes with hypertension risk

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Abstract

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.

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Most cited references 76

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The development of instruments to measure the work disability assessment behaviour of insurance physicians

Romy Steenbeek, Antonius JM Schellart, Henny PG Mulders … (2011)

Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.

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Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data

Mark D. Robinson, Deborah Shipton, David J Walsh … (2015)

Background Regional differences in population levels of alcohol-related harm exist across Great Britain, but these are not entirely consistent with differences in population levels of alcohol consumption. This incongruence may be due to the use of self-report surveys to estimate consumption. Survey data are subject to various biases and typically produce consumption estimates much lower than those based on objective alcohol sales data. However, sales data have never been used to estimate regional consumption within Great Britain (GB). This ecological study uses alcohol retail sales data to provide novel insights into regional alcohol consumption in GB, and to explore the relationship between alcohol consumption and alcohol-related mortality. Methods Alcohol sales estimates derived from electronic sales, delivery records and retail outlet sampling were obtained. The volume of pure alcohol sold was used to estimate per adult consumption, by market sector and drink type, across eleven GB regions in 2010–11. Alcohol-related mortality rates were calculated for the same regions and a cross-sectional correlation analysis between consumption and mortality was performed. Results Per adult consumption in northern England was above the GB average and characterised by high beer sales. A high level of consumption in South West England was driven by on-trade sales of cider and spirits and off-trade wine sales. Scottish regions had substantially higher spirits sales than elsewhere in GB, particularly through the off-trade. London had the lowest per adult consumption, attributable to lower off-trade sales across most drink types. Alcohol-related mortality was generally higher in regions with higher per adult consumption. The relationship was weakened by the South West and Central Scotland regions, which had the highest consumption levels, but discordantly low and very high alcohol-related mortality rates, respectively. Conclusions This study provides support for the ecological relationship between alcohol-related mortality and alcohol consumption. The synthesis of knowledge from a combination of sales, survey and mortality data, as well as primary research studies, is key to ensuring that regional alcohol consumption, and its relationship with alcohol-related harms, is better understood.

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Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference

Margaret Ashwell, Sigrid Gibson (2016)

Objectives There is now good evidence that central obesity carries more health risks compared with total obesity assessed by body mass index (BMI). It has therefore been suggested that waist circumference (WC), a proxy for central obesity, should be included with BMI in a ‘matrix’ to categorise health risk. We wanted to compare how the adult UK population is classified using such a ‘matrix’ with that using another proxy for central obesity, waist-to-height ratio (WHtR), using a boundary value of 0.5. Further, we wished to compare cardiometabolic risk factors in adults with ‘healthy’ BMI divided according to whether they have WHtR below or above 0.5. Setting, participants and outcome measures Recent data from 4 years (2008–2012) of the UK National Diet and Nutrition Survey (NDNS) (n=1453 adults) were used to cross-classify respondents on anthropometric indices. Regression was used to examine differences in levels of risk factors (triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), TC: HDL, glycated haemoglobin (HbA1c), fasting glucose, systolic (SBP) and diastolic blood pressure (DBP)) according to WHtR below and above 0.5, with adjustment for confounders (age, sex and BMI). Results 35% of the group who were judged to be at ‘no increased risk’ using the ‘matrix’ had WHtR ≥0.5. The ‘matrix’ did not assign ‘increased risk’ to those with a ‘healthy’ BMI and ‘high’ waist circumference. However, our analysis showed that the group with ‘healthy’ BMI, and WHtR ≥0.5, had some significantly higher cardiometabolic risk factors compared to the group with ‘healthy’ BMI but WHtR below 0.5. Conclusions Use of a simple boundary value for WHtR (0.5) identifies more people at ‘early health risk’ than does a more complex ‘matrix’ using traditional boundary values for BMI and WC. WHtR may be a simpler and more predictive indicator of the ‘early heath risks’ associated with central obesity.

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Author and article information

Journal

Journal ID (nlm-ta): Medicine (Baltimore)

Journal ID (iso-abbrev): Medicine (Baltimore)

Journal ID (publisher-id): MEDI

Title: Medicine

Publisher: Wolters Kluwer Health

ISSN (Print): 0025-7974

ISSN (Electronic): 1536-5964

Publication date Collection: November 2018

Publication date (Electronic): 30 November 2018

Volume: 97

Issue: 48

Electronic Location Identifier: e13262

Affiliations

[a ]State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases

[b ]School of Public Health, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing

[c ]Jiangsu Province Center for Disease Control & Prevention

[d ]Jiangxinzhou Community Health Service Center, Nanjing

[e ]Academy of Military Sciences, People's Liberation Army of China, Beijing, China.

Author notes

[∗ ]Correspondence: Wei Li, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102300, China (e-mail: liwei@ 123456mrbc-nccd.com ), Yu Jiang, School of Public Health, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 102300, China (e-mail: jiangyu@ 123456pumc.edu.cn ).

Article

Publisher ID: MD-D-18-04402 Accession ID: 13262

DOI: 10.1097/MD.0000000000013262

PMC ID: 6283208

PubMed ID: 30508913

SO-VID: b0d5270e-ab52-4dfe-a6fa-565f8df8a4c7

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

History

Date received : 25 June 2018

Date accepted : 23 October 2018

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Keywords: body mass index,hypertension,meta-analysis,systematic review,waist circumstance,waist-to-height ratio,waist-to-hip ratio

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Keywords: body mass index, hypertension, meta-analysis, systematic review, waist circumstance, waist-to-height ratio, waist-to-hip ratio

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

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Karger: Nutrition and Dietetics

Most cited references 76

The development of instruments to measure the work disability assessment behaviour of insurance physicians

Regional alcohol consumption and alcohol-related mortality in Great Britain: novel insights using retail sales data

Waist-to-height ratio as an indicator of ‘early health risk’: simpler and more predictive than using a ‘matrix’ based on BMI and waist circumference

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