Obesity in urban middle class in Delhi. Practical human Biology Anthropometry. New York: Academic Press; WHO expert consultation. Appropriate body mass index for Asian population and its implication for policy and intervention strategies. JNC 7. The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure. Predictors of age related increase in blood pressure in men and women. Ann Hum Biol. Sex differences and Relationship between blood pressure and age among the Igbos of Nigeria.
Internet J Biol Anthropol. Gupta R, Mehrishi S. Waist-hip ratio and blood pressure correlation in an urban Indian population. J Indian Med Assoc. Diet nutrition and the prevention of Chronic diseases. Report of WHO study group. Word Health Organisation. WHO Technical. Body mass index, abdominal adiposity and blood pressure: Consistency of their association across developing and developed countries. Blood pressure and waist circumference: An empirical study of the effects of waist circumference on blood pressure among Bengalee male jute workers of Belur, West Bengal, India.
J Assoc Physician India. Blood pressure, body mass index and risk of cardiovascular disease in Chinese men and women. BMC Public Health. Prevalence of prehypertension and its relationship to risk factors for cardiovascular disease in Jamaica: Analysis from a cross- sectional survey.
BMC Cardiovasc Disord. The protective effects of estrogen on the cardiovascular system. N Engl J Med. The relationship between blood pressure and biochemical risk factors in a general population. Br J Prev Soc Med. Tyagi R. Body composition and nutritional status of the institutionalised and non-institutionalised senior citizens. Gupta S, Kapoor S.
Sex differences in blood pressure levels and its association with obesity indices: Who is at greater risk. Ethn Dis. Hypertension screening of 1 million Americans. Rebuffle-Strive M, Bjorntopp P. Regional adipose tissue metabolism in man. Metabolic complications of human obesities. Amsterdam: Excerpta Medica; Definition of chronic energy deficiency in adults. Eur J Clin Nutr. A simplified approach of assessing adult energy deficiency. Food and Nutrition paper Rome: Food and Agriculture Organisation; Body Mass Index: A measure of chronic energy deficiency in adults.
Nutritional status and ageing among populations. Inhabiting varied geological regions in India. Biennial Book of EAA. Relationship between blood pressure and anthropometry in a cohort of Brazilian men: A cross-sectional study.
Am J Hypertens. Pressure among Punjabi Khatris. Unpublished Delhi: University of Delhi; Dua nee Verma Suman. Anthropological study of Blood. Dua S, Kapoor S. Blood pressure, waist to hip ratio and body mass index among affluent Punjabi girls of Delhi. Acta Med Auxol. Abdominal obesity in the United States: Prevalence and attributable risk of hypertension. J Hum Hypertens.
Weder AB. Membrane sodium transport. Hypertension Primer. The Kenyan Luo migration study: Observations on the initiation of a rise in blood pressure. Prevalence of heart disease and stroke risk factors among adults in United States, The only exclusion criteria are: self-reported pregnancy, incapacity to perform the physical performance tests, denial of blood capillary check, and the inability or the refusal to give written informed consent.
Between June 1st, and October 30th, , we enrolled participants. For the present study, participants were excluded for missing values in the variables of interest; as a consequence, a sample of participants was considered. Well-trained examiners, measured anthropometric indices with participants wearing light, thin clothing and no shoes. Body weight was measured through an analogue medical scale.
Body height was measured using a standard stadiometer. Body weight and height were measured to the nearest 0. BMI was defined as weight kilograms divided by the square of height meters. Obesity was categorized as class I 30— Blood pressure was measured—in the sample of Milan EXPO —with a clinically validated Omron M6 electronic sphygmomanometer Omron, Kyoto, Japan and in all other samples with a manual sphygmomanometer according to recommendations from international guidelines [ 26 ].
In all participants, blood pressure measurements were obtained after resting for 5 min in a seated position, with 30 s intervals between cuff inflations. An average of three measurements were used. In all the experimental settings, the assessment was performed in a dedicated room, with an optimal room temperature, and respecting the privacy.
Antihypertensive drug use was also recorded. Daily intake of fruit and vegetables was calculated on the reference tables for the Italian population released by the Italian Society of Nutrition SINU. The use of three or more portions to identify a healthy diet is in line with Italian dietary habits for fruit and vegetables, which are typically eaten during the main meals rather than as snacks. Regular participation in physical activity was considered as involvement in exercise training at least twice a week during the last year.
Accordingly, participants were considered physically active or inactive. To be assigned in the active group, the following activities were considered: walking for at least 30 min per session, cycling, swimming, running, and resistance exercise [ 20 , 29 ].
Cholesterol was measured from capillary blood samples using disposable electrode strips based on a reflectometric system with a portable device MultiCare-In, Biomedical Systems International Srl, Florence, Italy [ 30 ]. The inter-assay imprecision expressed as variation coefficient of the MultiCare system was 4. Random blood glucose was measured from capillary blood samples using disposable electrode strips based on an amperometric system with a MultiCare-In portable device [ 30 ].
Descriptive statistics were used to define demographic and key clinical characteristics of the study population according to the presence of hypertension. Logistic regression analysis was used to assess the association between different levels of BMI normal weight, overweight, and obesity and hypertension.
A logistic regression analysis was computed including the five cardiovascular health metrics smoking, healthy diet, physical activity, cholesterol, and serum glucose level. All analyses were performed using SPSS software version Characteristics of the study population according to the presence of hypertension are summarized in Table 1.
As compared with women, men had a higher prevalence of hypertension. Participants with hypertension were significantly older than those without hypertension In particular, hypertensive participants showed higher prevalence of diabetes and cholesterol levels than non-hypertensive enrollees.
Finally, the BMI value was significantly higher in participants with hypertension than in non-hypertensive participants Physically active: physical exercise at least twice a week. BMI: body mass index. As shown in Figure 2 , the prevalence of hypertension significantly increased with the increase in BMI.
In the unadjusted model, there was a direct association between BMI levels and hypertension, starting from overweight [odds ratio OR 2. After adjusting for potential confounders—age, gender, smoking habit, healthy diet, physical activity, cholesterol and glucose levels—this association remained statistically significant.
In the fully adjusted model, participants with class III obesity had a significantly increased risk of hypertension compared with those with normal BMI OR 6. Model 1: adjusted for age and gender; Model 2: adjusted for age, gender, smoking habit, healthy diet, physical activity, cholesterol, and diabetes.
We also tested the possible interaction between gender and BMI for the diagnosis of hypertension, but no significant result was reported. Using this innovative database, the present study shows that both systolic and diastolic blood pressure values are linearly correlated with BMI; in particular, overweight and obesity status were significant risk factors for hypertension. While age and gender usually affect the prevalence of hypertension, BMI remained the main determinant when the analyses were stratified by gender and adjusted for age.
A significant association was also observed for BMI even after adjusting for other covariates, suggesting that overweight and obesity per se may lead to the development of hypertension and play a central role in its pathogenesis [ 31 ].
The overweight status, which reflects increased body fat mass, was demonstrated to be an independent risk factor for hypertension, which was consistent with previous studies showing an association between high body fat levels and hypertension [ 7 , 10 , 32 , 33 , 34 ]. However, the exact mechanism underlying the association of visceral fat and hypertension remains unknown. Inflammatory processes have been shown to play an important role in the mechanisms involved in the pathogenesis of hypertension [ 35 ].
Fat cells are characterized by being sensitive to lipolysis and by their aptitude to produce high quantities of inflammatory cytokines. This inflammatory response participates in blood pressure elevation and end-organ damage.
Furthermore, it is possible that increased adipose tissue releases a variety of adipokines that are related to a decrease in the production and use of nitric oxide, which has important functions in the control of vascular tone and suppression of vascular smooth muscle cell proliferation.
A decrease in the effect of nitric oxide has been associated with endothelial dysfunction and arterial hypertension [ 36 ]. Overall, the cardiovascular health metrics score has recently been associated with a lower risk of cardiovascular and non-cardiovascular mortality, with clear benefits on arterial stiffness [ 37 ], carotid intima media thickness [ 38 ], and coronary artery calcification [ 39 ], linking the potential importance of these factors to improvements in health and successful longevity free of CVD.
In particular, vascular risk factors, which are represented by ideal cardiovascular health metrics components and, in particular, BMI may be correlated not only with clear signs and symptoms of diseases, but also with an accumulation of subclinical vascular disorders, resulting in a higher blood pressure preceding the onset of clinically evident manifestation of hypertension [ 40 ].
Along with prior publications, the present study demonstrates the importance of promoting ideal and normal body weight as a national strategy, not just for the general reduction of CVD, but also for its favorable impact on blood pressure.
Body weight and BMI are easily measured and are simple and effective tools for screening the risk of hypertension, making these anthropometric measures suitable for use in comprehensive public health strategies. The prevalence of obesity has been increasing significantly in Western countries over recent years, and the burden of hypertension is expected to continue to increase. Therefore, the use of BMI should be recommended when looking to predict and screen for hypertension.
Albeit dealing with a highly relevant issue, our study presents some important limitations that need to be discussed. First, the results shown in this paper were obtained from a cross-sectional survey limiting the ability to draw cause-and-effect implications between different levels of BMI and hypertension.
As a consequence the ability to recognize whether a normal BMI is correlated with the postponement of higher blood pressure over time is limited. Second, the type of evaluation could influence the assessment of some health metrics.
For example, the chosen setting of Milan EXPO or some shopping centers could lead to an overestimation of the blood pressure. Even though the blood pressure was measured according to recommendations from international guidelines, people who decided to participate in the study procedures were involved—before being assessed—in usual activities, such as walking, carrying bags, and eating.
The activities, performed immediately before being evaluated, could have influenced the assessment. Limitations also include lack of information about conditions, such as stroke, myocardial infarct, and other CVD that have a direct impact on blood pressure. However, for the type of participants recruited in the study, it is possible to exclude that acute illnesses were present at the time of evaluation.
Furthermore, given the type of the check-up, we have no information about triglycerides, HDL and LDL cholesterol levels. For this reason, it was not possible to take this important parameter into consideration.
A deeper understanding of the relationship between BMI and hypertension requires the analysis of prospective data that are not available at this stage for our study.
Finally, the population included only Caucasian persons, so our results may not be applicable to other ethnic groups. Apart from these limitations, this study offered a unique opportunity to investigate the impact of BMI on blood pressure. We found a gradient of increasing blood pressure with higher levels of BMI.
Nevertheless, despite extensive research efforts, the mechanism responsible for BMI-associated improvement in blood pressure has not been completely elucidated. For example, the connections among obesity, diabetes, and hypertension could explain, at least in part, the results observed.
Diabetes represents an independent risk factor for CVD and at the same time obesity is a risk factor for diabetes. Participants in the Kailuan study who attended all five annual physical examinations in , , , , and were selected as observation subjects.
In total, 32, cases were included in the statistical analysis. We used average real variability to evaluate long-term systolic BPV. After adjusting for other confounding factors, stepwise multivariate linear regression analysis showed that ARVSBP increased by 0. Multiple logistic regression analysis indicated that being obese or overweight, compared with being normal-weight, were risk factors for an increase in ARVSBP.
The corresponding odds ratios of being obese or overweight were 1. Registration No. Peer Review reports. In , research on the global burden of disease showed that obesity or overweight were responsible for 3. Body mass index BMI is an indicator used to systematically measure obesity and overweight status. BMI has been broadly applied in research relating to obesity and overweight because of its convenience of use.
Research has shown that high BMI is a risk factor for hypertension and cardiovascular events CVEs [ 3 , 4 , 5 , 6 , 7 ]. Hypertension and risk of CVEs are, respectively, 4. Obesity and overweight are not only risk factors for hypertension; they are also related to changes in blood pressure BP.
Faramawi [ 8 ] found that, for every one-unit increase in BMI, short-term blood pressure variability BPV increased by 0. The Kailuan study Registration No. Since , a physical examination has been conducted every 2 years among the observation group. All the staff came from China. They were included in the study subjects if they had met the following criteria: aged 18 years or older; with complete data on height and weight; with no history of CVEs.
The investigation content, anthropometric measurements, and biochemical index tests were identical at each wave. Those who had missed any systolic blood pressure SBP test across the five study waves and incidence of CVEs between first and fifth physical examinations were excluded.
In accordance with the Helsinki Declaration, this study has been approved by the Ethics Committee of Kailuan General Hospital, and written informed consent was obtained from all individuals in the observation group. Details of the epidemiological investigation and anthropometry index have been described elsewhere [ 12 ].
Smoking was operationalized as smoking at least one cigarette per day on average in the last year. Physical exercise was defined as exercising more than three times per week, with each time lasting more than 30 min. CVEs included stroke namely, hemorrhagic stroke or ischemic stroke and myocardial infarction. Trained medical staff members checked all of the inpatient diagnoses for individuals in the study group at the hospitals in the Kailuan Group and at the hospitals that were municipally listed for medical insurance every year.
These staff members also recorded final events. All of these diagnoses were confirmed by professional doctors in line with inpatient records. For the measurement of BP, subjects were required to refrain from smoking or drinking tea or coffee for 30 min before the measurement and to sit upright for 15 min quietly.
The first four physical examinations used an adjusted mercury sphygmomanometer to test the BP of the right brachial artery. Daling China was used to measure the BP of the right brachial artery.
During each physical examination, BP was tested three times, with an interval of 1 min between tests, and the average of these three readings was recorded as the final BP of each subject. For these measurements, the subjects were barefoot, had nothing on their heads, wore light clothing, and stood upright. Height was measured to the nearest 0. Blood samples taken from the antecubital vein were collected in EDTA tubes from the participants fasting overnight.
By centrifugating at g for 10 min centrifuge radius of 17 cm at room temperature, plasma was then isolated. The measurement of supernatant serum was carried out in 4 h. All biochemical variables were measured by an automatic biochemical analyzer Hitachi ; Hitachi, Tokyo, Japan. ARV requires that the order of the BP readings be in line with the formula. This measurement can better predict damage to the target organ [ 14 , 15 , 16 ].
All of the information from the physical examinations was recorded by unifying trained professional staff members and gathered by Kailuan General Hospital. SPSS Including patients with hypertension and those taking antihypertensive drugs, and using different methods of measuring BP may affect our assessment of long-term BPV.
A total of , subjects were enrolled in the physical examination in Excluding the cases with previous CVEs and the cases with incomplete information or missing weight or height at the first physical examination reduced the sample to 37, cases who took part in physical examinations in all of the study years , , , and We then excluded the cases with missing data on SBP at any physical examination and the cases of new occurrence of CVEs during the study period.
Finally, the remaining 32, cases including 24, men [ The differences in BMI, salt intake, and drinking alcohol were not statistically significant see Table 2. In this part of the analysis, ARVSBP group was the dependent variable, and BMI group was the independent variable of interest, with normal-weight as the reference category. The sensitivity analysis was conducted after separately excluding those with hypertension, those taking antihypertensive drugs, those who were underweight, and measures of BP from the fifth physical examination.
However, in a year follow-up study of children with an average age of 14, Li et al. The results of the present study are consistent with previous studies on the relationship between BMI and short-term BPV. Observing 14, people who had undergone health examinations in the United States, Faramawi et al. In their observation of hypertensive people, Qian et al. The inclusion of subjects who were taking antihypertensive drugs and the use of different measurement methods could have had an impact on our findings for ARVSBP.
Thus, the present study included a sensitivity analysis that was conducted separately, excluding those with hypertension, those taking antihypertensive drugs, those in the underweight group, and BP measured at the fifth physical examination.
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