Association Between Different measurements of Obes

Authors: Gus Miguel Fuchs Sandra C Moreira Leila B Moraes Renan S Wiehe Mário Silva André F Albers Félix Fuchs Flávio D

Publish Date: 2004/01/01

Volume: 17, Issue: 1, Pages: 50-53

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Abstract

Miguel Gus Sandra C Fuchs Leila B Moreira Renan S Moraes Mário Wiehe André F Silva Félix Albers Flávio D Fuchs Association Between Different measurements of Obesity and the Incidence of Hypertension American Journal of Hypertension Volume 17 Issue 1 January 2004 Pages 50–53 https//doiorg/101016/jamjhyper200308010In the baseline evaluation of a populationbased cohort 1089 adults answered a pretested questionnaire and had their baseline blood pressure BP and anthropometric measurements assessed according to standardized recommendations Excluding the individuals with hypertension at baseline and those deceased or lost during the followup 592 individuals 805 of those eligible were visited again Obesity was defined as BMI ≥30 kg/m2 for both genders and WC ≥102 cm for men and WC ≥88 cm for women Incident cases of hypertension were characterized by BP ≥140/90 mm Hg or use of BP medication in the followup visitAfter a mean followup of 56 ± 11 years 127 incident cases of hypertension were identified The hazard ratios Cox model adjusted for age and baseline systolic BP 95 CI and P for BMI higher than 30 kg/m2 were 108 052–224 P = 82 in men and 174 093–326 P = 08 in women The corresponding figures were 178 076–409 P = 18 for men with WC ≥102 and 172 109–273 P = 02 for women with WC ≥88 cmCoronary artery disease stroke and other manifestations of cardiovascular disease CVD are secondary to an integrated response to multiple cardiovascular risk factors such as hypertension type 2 diabetes and hyperlipidemia These cardinal metabolic risk factors for cardiovascular disease are typically obesity related1–4 In addition obesity is strongly associated with sleep disorders another independent risk factor for CVD5 Due to clustering and synergistic mechanisms with these risk factors and through its independent association with CVD obesity may be recognized as a major risk factor for CVDThe 1998 National Institutes of Health NIH guidelines on the identification evaluation and treatment of overweight and obesity in adults defined these conditions in terms of body mass index BMI calculated as weight in kilograms divided by square of height in meters and waist circumference WC The sexspecific defining cutoff points were 30 kg/m2 for BMI in both genders and 102 cm and 88 cm for WC in men and women respectively5 Crosssectional surveys have shown that WC has a higher ability than BMI in identifying the presence of risk factors for CVD67 Even in individuals with normal BMI high WC values were related to hypertension diabetes and dyslipidemia8 Longterm studies on the association between different anthropometric measurements and the incidence of CVD or mortality have showed conflicting results9–14 The longitudinal association between different definitions of obesity and the incidence of hypertension was scarcely described to date and have compared BMI and waist–hip ratio WHR14 or had the diagnosis of hypertension based on selfreported questionnaire9 The aim of this study was to explore the longitudinal association between different indices of obesity with the incidence of hypertension in a populationbased cohort of adults living in Porto Alegre a state capital in southern BrazilBaseline data collection of this study has been described in detail elsewhere315 In brief 1091 individuals identified through crosssectional populationbased multistage probability sampling were interviewed at home after obtaining informed consent Assessment of demographic data education number of years at school cigarette smoking presence of cardiovascular disease diabetes or other diseases diagnosed by a physician per capita income alcoholic beverage consumption and other characteristics was done with a structured and pretested questionnaire Sitting blood pressure BP was measured after 5 min of rest using aneroid sphygmomanometers according to standardized recommendations The average of two measurements was used in the analyses Anthropometric measurements were carried out with participants wearing light clothing and no shoes Interviewers were trained in the application of the questionnaire and measurement of BP using a double stethoscope A portable scale was used to measure body weight Standing body height was measured with the use of a measuring tape with the shoulders in relaxed position and arms hanging freely The WC was measured in centimeters with participants standing above the iliac crests and below the lowest rib margin at minimum respiration The supervisors directly checked 10 of the interviews at random Followup data were obtained in another visit 60 ± 17 years after the first visit Information from relatives neighbors and registers from the power and water companies were used to find participants who changed address A new questionnaire was applied and the measurements carried out at the baseline visit were repeated Incident cases of hypertension were defined as systolic BP of at least 140 mm Hg or diastolic at least 90 mm Hg or use of antihypertensive drugs after the average of the two BP measurements Data were described in terms of mean ± SD or frequency and percentage Cox proportional hazards models were used to explore the relation between obesity defined by BMI and WC at baseline and incidence of hypertension adjusting for potential confounders Tests for interactions were not allowed The sample size was calculated to test hypotheses explored in the crosssectional survey3 Therefore the study was not powered to investigate the longitudinal associations and their findings should be taken as estimates of real risks The study was approved by the Ethics Committee of our institutionA total of 71 individuals were deceased and 199 were lost to followup leading to a total of 819 individuals in the whole cohort available for analysis After excluding 227 who were hypertensive in the first visit 592 individuals were included in the present analysis After a mean followup of 56 ± 11 years 127 incident cases of hypertension were identified Table 1 shows the distribution of some characteristics in men and women classified as obese by the different criteria The individuals classified as obese whichever the definition used tended to be older to have a lower socioeconomic profile and higher BP levels In men there was a greater proportion of alcohol abusers among those defined as obese at baseline

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