Obesity indices predict hypertension among indigenous adults in Krau Wildlife Reserve, Peninsular Malaysia

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Abstract

Background

The disease burden of indigenous peoples has been augmented by the rising prevalence of obesity and hypertension in this population. This study assessed the ability of obesity indices to predict hypertension among indigenous adults of Peninsular Malaysia.

Methods

In this cross-sectional study, 482 adults (223 men, 259 women) aged ≥18 years old were measured for body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), and blood pressure. Receiver operating characteristic (ROC) analysis was used to determine the predictive ability of obesity indices for hypertension in men and women. Gender-specific logistic regression analyses were done to examine the association between obesity, defined by BMI, WC, WHtR and WHR, and hypertension.

Results

Prevalence of hypertension was 25.5%. Overall, WHtR was the best predictor of the presence of hypertension, in both men and women. The optimal WHtR cut-off values for hypertension were 0.45 and 0.52 in men and women, respectively. Obese adults with WHtR ≥0.5 had about two times increased odds of having hypertension compared to non-obese adults.

Conclusions

WHtR may serve as a simple and inexpensive screening tool to identify individuals with hypertension in this relatively difficult to reach population.

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Most cited references 40

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Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore

Benjamin Chih Chiang Lam, Gerald Koh, Cynthia Chen … (2015)

Background Excess adiposity is associated with cardiovascular disease (CVD) risk factors such as hypertension, diabetes mellitus and dyslipidemia. Amongst the various measures of adiposity, the best one to help predict these risk factors remains contentious. A novel index of adiposity, the Body Adiposity Index (BAI) was proposed in 2011, and has not been extensively studied in all populations. Therefore, the purpose of this study is to compare the relationship between Body Mass Index (BMI), Waist Circumference (WC), Waist-to-Hip Ratio (WHR), Waist-to-Height Ratio (WHtR), Body Adiposity Index (BAI) and CVD risk factors in the local adult population. Methods and Findings This is a cross sectional study involving 1,891 subjects (Chinese 59.1% Malay 22.2%, Indian 18.7%), aged 21–74 years, based on an employee health screening (2012) undertaken at a hospital in Singapore. Anthropometric indices and CVD risk factor variables were measured, and Spearman correlation, Receiver Operating Characteristic (ROC) curves and multiple logistic regressions were used. BAI consistently had the lower correlation, area under ROC and odd ratio values when compared with BMI, WC and WHtR, although differences were often small with overlapping 95% confidence intervals. After adjusting for BMI, BAI did not further increase the odds of CVD risk factors, unlike WC and WHtR (for all except hypertension and low high density lipoprotein cholesterol). When subjects with the various CVD risk factors were grouped according to established cut-offs, a BMI of ≥23.0 kg/m2 and/or WHtR ≥0.5 identified the highest proportion for all the CVD risk factors in both genders, even higher than a combination of BMI and WC. Conclusions BAI may function as a measure of overall adiposity but it is unlikely to be better than BMI. A combination of BMI and WHtR could have the best clinical utility in identifying patients with CVD risk factors in an adult population in Singapore.

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Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study.

Sanjay Basu, Christopher Millett (2013)

Large-scale hypertension screening campaigns have been recommended for middle-income countries. We sought to identify sociodemographic predictors of hypertension prevalence, diagnosis, treatment, and control among middle-income countries. We analyzed data from 47 443 adults in all 6 middle-income countries (China, Ghana, India, Mexico, Russia, and South Africa) sampled in nationally representative household assessments from 2007 to 2010 as part of the World Health Organization Study on Global Aging and Adult Health. We estimated regression models accounting for age, sex, urban/rural location, nutrition, and obesity, as well as hypothesized covariates of healthcare access, such as income and insurance. Hypertension prevalence varied from 23% (India) to 52% (Russia), with between 30% (Russia) and 83% (Ghana) of hypertensives undiagnosed before the survey and between 35% (Russia) and 87% (Ghana) untreated. Although the risk of hypertension significantly increased with age (odds ratio, 4.6; 95% confidence interval, 3.0-7.1; among aged, 60-79 versus <40 years), the risk of being undiagnosed or untreated fell significantly with age. Obesity was a significant correlate to hypertension (odds ratio, 3.7; 95% confidence interval, 2.1-6.8 for obese versus normal weight), and was prevalent even among the lowest income quintile (13% obesity). Insurance status and income also emerged as significant correlates to diagnosis and treatment probability, respectively. More than 90% of hypertension cases were uncontrolled, with men having 3 times the odds as women of being uncontrolled. Overall, the social epidemiology of hypertension in middle-income countries seems to be correlated to increasing obesity prevalence, and hypertension control rates are particularly low for adult men across distinct cultures.

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Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications.

Norbert Stefan, Hans-Ulrich Häring, Frank Hu … (2016)

Among chronic non-communicable diseases, cardiometabolic diseases and cancer are the most important causes of morbidity and mortality worldwide. Although high BMI and waist circumference, as estimates of total and abdominal fat mass, are now accepted as predictors of the increasing incidence of these diseases, adult height, which also predicts mortality, has been neglected. Interestingly, increasing evidence suggests that height is associated with lower cardiometabolic risk, but higher cancer risk, associations supported by mendelian randomisation studies. Understanding the complex epidemiology, biology, and pathophysiology related to height, and its association with cardiometabolic diseases and cancer, is becoming even more important because average adult height has increased substantially in many countries during recent generations. Among the mechanisms driving the increase in height and linking height with cardiometabolic diseases and cancer are insulin and insulin-like growth factor signalling pathways. These pathways are thought to be activated by overnutrition, especially increased intake of milk, dairy products, and other animal proteins during different stages of child development. Limiting overnutrition during pregnancy, early childhood, and puberty would avoid not only obesity, but also accelerated growth in children-and thus might reduce risk of cancer in adulthood.

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Author and article information

Contributors

Ee Yin Chua: eeyinchua@gmail.com

Mohd Shariff Zalilah: 60389472472 , zalilahms@upm.edu.my

Karppaya Haemamalar: haemamalar@isn.gov.my

Sulaiman Norhasmah: norhasmah@upm.edu.my

Appannah Geeta: geeta@upm.edu.my

Journal

Journal ID (nlm-ta): J Health Popul Nutr

Journal ID (iso-abbrev): J Health Popul Nutr

Title: Journal of Health, Population, and Nutrition

Publisher: BioMed Central (London )

ISSN (Print): 1606-0997

ISSN (Electronic): 2072-1315

Publication date (Electronic): 25 May 2017

Publication date PMC-release: 25 May 2017

Publication date Collection: 2017

Volume: 36

Electronic Location Identifier: 24

Affiliations

ISNI 0000 0001 2231 800X, GRID grid.11142.37, Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, , Universiti Putra Malaysia, ; 43400 UPM Serdang, Selangor Darul Ehsan Malaysia

Article

Publisher ID: 102

DOI: 10.1186/s41043-017-0102-4

PMC ID: 5445453

PubMed ID: 28545536

SO-VID: 75236117-7a7a-4157-8446-53e021178766

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 June 2016

Date accepted : 17 May 2017

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: obesity indices,hypertension,indigenous peoples,waist-height ratio,predictor

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: obesity indices, hypertension, indigenous peoples, waist-height ratio, predictor

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Obesity indices predict hypertension among indigenous adults in Krau Wildlife Reserve, Peninsular Malaysia

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Abstract

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Karger: Nutrition and Dietetics

Most cited references 40

Comparison of Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Waist-To-Hip Ratio (WHR) and Waist-To-Height Ratio (WHtR) as Predictors of Cardiovascular Disease Risk Factors in an Adult Population in Singapore

Social epidemiology of hypertension in middle-income countries: determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study.

Divergent associations of height with cardiometabolic disease and cancer: epidemiology, pathophysiology, and global implications.

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