Body Fat Distribution and Systolic Blood Pressure in 10,000 Adults with Whole‐Body Imaging: UK Biobank and Oxford BioBank

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Abstract

Objective

This study aimed to quantify the associations of regional fat mass and fat‐free mass with systolic blood pressure.

Methods

This analysis combined individual participant data from two large‐scale imaging studies: UK Biobank and Oxford BioBank. In both studies, participants were interviewed and measured, and they underwent dual‐energy x‐ray absorptiometry imaging. Linear regression was used to relate systolic blood pressure to anthropometric measures of adiposity (BMI, waist circumference, and waist to hip ratio) and dual‐energy x‐ray absorptiometry–derived measures of body composition (visceral android fat, subcutaneous android fat, subcutaneous gynoid fat, and fat‐free mass).

Results

Among 10,260 participants (mean age 49; 96% white), systolic blood pressure was positively associated with visceral android fat (3.2 mmHg/SD in men; 2.8 mmHg/SD in women) and fat‐free mass (1.92 mmHg/SD in men; 1.64 mmHg/SD in women), but there was no evidence of an association with subcutaneous android or gynoid fat. Associations of systolic blood pressure with BMI were slightly steeper than those with waist circumference or waist to hip ratio; these associations remained unchanged following adjustment for fat‐free mass, but adjustment for visceral android fat eliminated associations with waist circumference and waist to hip ratio and more than halved associations with BMI.

Conclusions

This analysis indicates that visceral fat is the primary etiological component of excess adiposity underlying the development of adiposity‐related hypertension.

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Most cited references 22

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National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Goodarz Danaei, Mariel M Finucane, John K Lin … (2011)

Data for trends in blood pressure are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. However, few worldwide analyses of trends in blood pressure have been done. We estimated worldwide trends in population mean systolic blood pressure (SBP). We estimated trends and their uncertainties in mean SBP for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (786 country-years and 5·4 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean SBP by age, country, and year, accounting for whether a study was nationally representative. In 2008, age-standardised mean SBP worldwide was 128·1 mm Hg (95% uncertainty interval 126·7-129·4) in men and 124·4 mm Hg (123·0-125·9) in women. Globally, between 1980 and 2008, SBP decreased by 0·8 mm Hg per decade (-0·4 to 2·2, posterior probability of being a true decline=0·90) in men and 1·0 mm Hg per decade (-0·3 to 2·3, posterior probability=0·93) in women. Female SBP decreased by 3·5 mm Hg or more per decade in western Europe and Australasia (posterior probabilities ≥0·999). Male SBP fell most in high-income North America, by 2·8 mm Hg per decade (1·3-4·5, posterior probability >0·999), followed by Australasia and western Europe where it decreased by more than 2·0 mm Hg per decade (posterior probabilities >0·98). SBP rose in Oceania, east Africa, and south and southeast Asia for both sexes, and in west Africa for women, with the increases ranging 0·8-1·6 mm Hg per decade in men (posterior probabilities 0·72-0·91) and 1·0-2·7 mm Hg per decade for women (posterior probabilities 0·75-0·98). Female SBP was highest in some east and west African countries, with means of 135 mm Hg or greater. Male SBP was highest in Baltic and east and west African countries, where mean SBP reached 138 mm Hg or more. Men and women in western Europe had the highest SBP in high-income regions. On average, global population SBP decreased slightly since 1980, but trends varied significantly across regions and countries. SBP is currently highest in low-income and middle-income countries. Effective population-based and personal interventions should be targeted towards low-income and middle-income countries. Funding Bill & Melinda Gates Foundation and WHO. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension.

R Huxley, W P T James, F Barzi … (2008)

Recent estimates indicate that two billion people are overweight or obese and hence are at increased risk of cardiovascular disease and its comorbidities. However, this may be an underestimate of the true extent of the problem, as the current method used to define overweight may lack sensitivity, particularly in some ethnic groups where there may be an underestimate of risk. Measures of central obesity may be more strongly associated with cardiovascular risk, but there has been no systematic attempt to compare the strength and nature of the associations between different measures of overweight with cardiovascular risk across ethnic groups. Data from the Obesity in Asia Collaboration, comprising 21 cross-sectional studies in the Asia-Pacific region with information on more than 263,000 individuals, indicate that measures of central obesity, in particular, waist circumference (WC), are better discriminators of prevalent diabetes and hypertension in Asians and Caucasians, and are more strongly associated with prevalent diabetes (but not hypertension), compared with body mass index (BMI). For any given level of BMI, WC or waist:hip ratio, the absolute risk of diabetes or hypertension tended to be higher among Asians compared with Caucasians, supporting the use of lower anthropometric cut-points to indicate overweight among Asians.

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The relationship of body mass and fat distribution with incident hypertension: observations from the Dallas Heart Study.

Alvin Chandra, Ian Neeland, Jarett D Berry … (2014)

Obesity has been linked to the development of hypertension, but whether total adiposity or site-specific fat accumulation underpins this relationship is unclear. This study sought to determine the relationship between adipose tissue distribution and incident hypertension. Normotensive participants enrolled in the Dallas Heart Study were followed for a median of 7 years for the development of hypertension (systolic blood pressure [SBP] ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or initiation of blood pressure medications). Visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) was quantified by magnetic resonance imaging and proton-spectroscopic imaging, and lower body fat (LBF) was imaged by dual-energy x-ray absorptiometry. Multivariable relative risk regression was performed to test the association between individual fat depots and incident hypertension, adjusting for age, sex, race/ethnicity, diabetes, smoking, SBP, and body mass index (BMI). Among 903 participants (median age, 40 years; 57% women; 60% nonwhite; median BMI 27.5 kg/m(2)), 230 (25%) developed incident hypertension. In multivariable analyses, higher BMI was significantly associated with incident hypertension (relative risk: 1.24; 95% confidence interval: 1.12 to 1.36, per 1-SD increase). However, when VAT, SAT, and LBF were added to the model, only VAT remained independently associated with incident hypertension (relative risk: 1.22; 95% confidence interval: 1.06 to 1.39, per 1-SD increase). Increased visceral adiposity, but not total or subcutaneous adiposity, was robustly associated with incident hypertension. Additional studies will be needed to elucidate the mechanisms behind this association. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Deborah Malden:

ORCID: https://orcid.org/0000-0003-0567-8294

deborah.malden@trinity.ox.ac.uk

Journal

Journal ID (nlm-ta): Obesity (Silver Spring)

Journal ID (iso-abbrev): Obesity (Silver Spring)

Journal ID (doi): 10.1002/(ISSN)1930-739X

Journal ID (publisher-id): OBY

Title: Obesity (Silver Spring, Md.)

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 1930-7381

ISSN (Electronic): 1930-739X

Publication date (Electronic): 13 May 2019

Publication date (Print): July 2019

Volume: 27

Issue: 7 ( doiID: 10.1002/oby.2019.27.issue-7 )

Pages: 1200-1206

Affiliations

[ ¹ ] Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health University of Oxford Oxford UK

[ ² ] Medical Research Council Population Health Research Unit Nuffield Department of Population Health, University of Oxford Oxford UK

[ ³ ] Oxford Centre for Diabetes, Endocrinology, and Metabolism University of Oxford Oxford UK

[ ⁴ ] Oxford Biomedical Research Centre, National Institute for Health Research Oxford University Hospitals Foundation Trust Oxford UK

[ ⁵ ] Cancer Epidemiology Unit University of Oxford Oxford UK

Author notes

[*] [* ] Correspondence: Deborah Malden ( deborah.malden@ 123456trinity.ox.ac.uk )

Author information

Deborah Malden https://orcid.org/0000-0003-0567-8294

Article

Publisher ID: OBY22509

DOI: 10.1002/oby.22509

PMC ID: 6618903

PubMed ID: 31081601

SO-VID: 5d83ed60-5b95-45b8-9a6d-81ddb1d2dc28

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 January 2019

Date accepted : 27 March 2019

Page count

Figures: 2, Tables: 2, Pages: 7, Words: 12532

Funding

Funded by: Medical Research Council

Award ID: MR/N013468/1

Funded by: National Institute for Health Research

Award ID: IS-BRC-1215-20008

Custom metadata

source-schema-version-number 2.0

component-id oby22509

cover-date July 2019

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.5 mode:remove_FC converted:10.07.2019

Body Fat Distribution and Systolic Blood Pressure in 10,000 Adults with Whole‐Body Imaging: UK Biobank and Oxford BioBank

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GLUT4 biology

Most cited references 22

National, regional, and global trends in systolic blood pressure since 1980: systematic analysis of health examination surveys and epidemiological studies with 786 country-years and 5·4 million participants.

Ethnic comparisons of the cross-sectional relationships between measures of body size with diabetes and hypertension.

The relationship of body mass and fat distribution with incident hypertension: observations from the Dallas Heart Study.

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