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Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries

Abstract

BACKGROUND: Obesity is increasing worldwide because developing countries are adopting Western high-fat foods and sedentary lifestyles. In parallel, in many of them, hypertension is rising more rapidly, particularly with age, than in Western countries.

OBJECTIVE: To assess the relationship between adiposity and blood pressure (BP) in a developing country with high average BP (The Seychelles, Indian Ocean, population mainly of African origin) in comparison to a developed country with low average BP (Switzerland, population mainly of Caucasian origin).

DESIGN: Cross-sectional health examination surveys based on population random samples.

SETTING: The main Seychelles island (Mahé) and two Swiss regions (Vaud-Fribourg and Ticino).

SUBJECTS: Three thousand one hundred and sixteen adults (age range 35–64) untreated for hypertension.

MEASUREMENTS: Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), systolic and diastolic blood pressure (SBP and DBP, mean of two measures).

METHODS: Scatterplot smoothing techniques and gender-specific linear regression models.

RESULTS: On average, SBP and DBP were found to increase linearly over the whole variation range of BMI, WHR and WC. A modest, but statistically significant linear association was found between each indicator of adiposity and BP levels in separate regression models controlling for age. The regression coefficients were not significantly different between the Seychelles and the two Swiss regions, but were generally higher in women than in men. For the latter, a gain of 1.7 kg/m2 in BMI, of 4.5 cm in WC or of 3.4% in WHR corresponded to an elevation of 1 mmHg in SBP. For women, corresponding figures were 1.25 kg/m2, 2.5 cm and 1.8% respectively. Regression coefficients for age reflected a higher effect of this variable on both SBP and DBP in the Seychelles than in Switzerland.

CONCLUSION: These findings suggest a stable linear relation of adiposity with BP, independent of age and body fat distribution, across developed and developing countries. The more rapid increase of BP with age observed in the latter countries are likely to reflect higher genetic susceptibility and/or higher cumulative exposure to another risk factor than adiposity.

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References

  1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL . Overweight and obesity in the United States Int J Obes Relat Metab Disord 1998 22: 39–47.

    Article  CAS  Google Scholar 

  2. Delpeuch F, Maire B . Obesity and developing countries of the south Med Trop 1997 57: 380–388.

    CAS  Google Scholar 

  3. James WP, Ralph A . New understanding in obesity research Proc Nutr Soc 1999 58: 385–393.

    Article  CAS  Google Scholar 

  4. Popkin BM . The nutrition transition and its health implications in lower-income countries Publ Health Nutr 1998 1: 5–21.

    Article  CAS  Google Scholar 

  5. Ghebremeskel K, Crawford MA . Nutrition and health in relation to food production and processing Nutr Health 1994 9: 237–253.

    Article  CAS  Google Scholar 

  6. Kaufman JS, Durazo-Arvizu RA, Rotimi CN, McGee DL, Cooper RS for the Investigators of the International Collaborative Study on Hypertension in Blacks . Obesity and hypertension prevalence in populations of African origin Epidemiology 1996 7: 398–405.

    Article  CAS  Google Scholar 

  7. Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S, Muna W, Kingue S, Fraser H, Forrester T, Bennett F, Wilks R . The prevalence of hypertension in seven populations of West African origin Am J Publ Health 1997 87: 160–168.

    Article  CAS  Google Scholar 

  8. Cooper R, Rotimi C . Hypertension in blacks Am J Hypertens 1997 10: 804–812.

    Article  CAS  Google Scholar 

  9. Forrester T, Cooper RS, Wetherall D . Emergence of Western diseases in the tropical world: the experience with chronic cardiovascular diseases Br Med Bull 1998 52: 463–473.

    Article  Google Scholar 

  10. Wilks R, Bennett F, Forrester T, McFarlane-Anderson N . Chronic disease: the new epidemic West Indian Med J 1998 47(Suppl 4): 40–44.

    PubMed  Google Scholar 

  11. Seidell JC, Cigolini M, Charzweska J, Ellsinger BM, Deslypere JP, Cruz A . Fat distribution in European men: a comparison of anthropometric measurements in relation to cardiovascular risk Int J Obes Relat Metab Disord 1992 16: 17–22.

    CAS  PubMed  Google Scholar 

  12. Seidell JC, Cigolini M, Charzweska J, Ellsinger BM, Di Biase G, Björntorp P, Hautvast GAJ, Contaldo F, Szostak V, Scuro LA . Indicators of fat distribution, serum lipids, and blood pressure in European women born in 1948—the European fat distribution study Am J Epidemiol 1989 130: 53–65.

    Article  CAS  Google Scholar 

  13. Ledoux M, Lambert J, Reeder BA, Després JP . Correlation between cardiovascular disease risk factors and simple anthropometric measures CMAJ 1997 157(Suppl 1): S46–S53.

    PubMed  Google Scholar 

  14. Shaper AG, Whincup PH . Hypertension in populations of African origin [editorial] Am J Publ Health 1997 87: 155–156.

    Article  CAS  Google Scholar 

  15. Bovet P, Shamlaye C, Kitua A, Riesen WF, Paccaud F, Darioli R . High prevalence of cardiovascular risk factors in the Seychelles (Indian Ocean) Arterioscler Thromb 1991 11: 1730–1736.

    Article  CAS  Google Scholar 

  16. WHO MONICA Project . WHO MONICA Project: risk factors Int J Epidemiol 1989 18 3 Suppl 1: S46–S55.

    Google Scholar 

  17. Wietlisbach V, Paccaud F, Rickenbach M, Gutzwiller F . Trends in cardiovascular risk factors (1984–1993) in a Swiss region: results of three population surveys Prev Med 1997 26: 523–533.

    Article  CAS  Google Scholar 

  18. Bovet P, Perret F, Shamlaye C, Darioli R, Paccaud F . The Seychelles Heart Study II: methods and basic findings Seychelles Medical and Dental Journal 1997 5: 8–24.

    Google Scholar 

  19. The guidelines subcommittee of the WHO-ISH Mild Hypertension Liaison committee . 1999 World Health Organization—International Society of Hypertension guidelines for the management of hypertension J Hypert 1999 17: 151–183.

    Google Scholar 

  20. Molarius A, Seidell JC, Sans S, Tuomilehto J, Kulaasmaa K for the WHO MONICA Project . Waist and hip circumferences, and waist-to-hip ratio in 19 populations of WHO MONICA Project Int J Obes Relat Metab Disord 1999 23: 116–125.

    Article  CAS  Google Scholar 

  21. Lean MEJ, Han TS, Morrison CE . Waist circumference as a measure for indicating need for weight management Br Med J 1995 311: 158–161.

    Article  CAS  Google Scholar 

  22. Macdonald SM, Reeder BA, Chen Y, Després JP . The Canadian Heart Health Survey Research Group CMAJ 1997 157(Suppl 1): S3–S9.

    PubMed  Google Scholar 

  23. Stata Corporation . Stata statistical software: release 6.0 Stata corporation 1999 1999 Stata Press, College Station, TX

    Google Scholar 

  24. Cleveland WS . Robust locally weighted regression and smoothing scatterplots J Am Stat Ass 1979 74: 829–836.

    Article  Google Scholar 

  25. Dustan HP . Obesity and hypertension in blacks Cardiovasc Drugs Ther 1990 4(Suppl 2): 395–402.

    Article  Google Scholar 

  26. Reaven MG . Pathophysiology of insulin resistance in human disease Physiol Rev 1995 75: 473–487.

    Article  CAS  Google Scholar 

  27. Schmidt MI, Watson RL, Duncan BB, Metcaff P, Brancati FL, Sharret AR, Davis CE, Heiss GH for the ARIC study . Clustering of dyslipidemia, hyperuricemia, diabetes, and hypertension and its association with fasting insulin and central and overall obesity in a general population Metabolism 1996 45: 699–706.

    Article  CAS  Google Scholar 

  28. Puig T, Marti B, Rickenbach M, Dai S, Casacuberta C, Wietlisbach V, Gutzwiller F . Association of body fat distribution with the blood lipid profile and blood pressure in middle-aged Swiss men and women Nutr Metab Cardiovasc Dis 1991 1: 170–177.

    Google Scholar 

  29. Croft JB, Strogatz DS, Keenan NL, James SA, Malarcher AM, Garrett JM . The independent effects of obesity and body fat distribution on blood pressure in black adults: the Pitt County study Int J Obes Relat Metab Disord 1993 17: 391–397.

    CAS  PubMed  Google Scholar 

  30. Okosun IS, Prewitt TE, Cooper RS . Abdominal obesity in the United States: prevalence and attributable risk of hypertension J Hum Hypertens 1999 13: 425–430.

    Article  CAS  Google Scholar 

  31. Van den Hoogen PGW, Feskens EJM, Nagelkerke NJD, Menotti A, Nissinen A, Kromhout D, for the Seven Countries Study Research Group . The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the World New Engl J Med 2000 342: 1–8.

    Article  Google Scholar 

  32. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J . Blood pressure, stroke and coronary heart disease. Part1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution effect Lancet 1990 335: 765–774.

    Article  CAS  Google Scholar 

  33. Osmond C, Barker DJ . Fetal, infant and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women Environ Health Perspect 2000 108(Suppl 3): 545–553.

    Article  Google Scholar 

  34. Curhan GC, Willet WC, Rimm EB, Spiegelman D, Ascherio AL, Stampfer MJ . Birth weight and adult hypertension, diabetes mellitus, and obesity in US men Circulation 1996 94: 3246–3250.

    Article  CAS  Google Scholar 

  35. Curhan GC, Chertow GM, Willet WC, Spiegelman D, Colditz GA, Manson JE, Speizer FE, Stampfer MJ . Birth weight and adult hypertension and obesity in women Circulation 1996 94: 1310–1315.

    Article  CAS  Google Scholar 

  36. Bovet P, Hungerbuhler P, Quilindo J, Grettve ML, Waeber B, Burnand B . Systematic difference between blood pressure readings caused by cuff type Hypertension 1994 24: 786–792.

    Article  CAS  Google Scholar 

  37. Gyarfas I . Control of hypertension in the population: strategies in affluent and developing countries Clin Exp Hypertens 1996 18: 387–397.

    Article  CAS  Google Scholar 

  38. Paccaud F, Schlütter-Fasmeyer V, Wietlisbach V, Bovet P . Dyslipidemia and abdominal obesity: an assessment in three general populations J Clin Epidemiol 2000 53: 393–400.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The Swiss MONICA Project has been financed by the Swiss National Science Foundation (grant numbers 3.856-0.83, 3.938.0.85, 32-9271.87, 32-30110.90) and the Cantons of Vaud and Ticino (Switzerland). Pascal Bovet has benefited from a grant by the Swiss National Foundation for Science (No. 3233-038792.93).

The authors wish to thank Martin Rickenbach, Michael Costanza, Silvia Franceschi and the two anonymous reviewers for their useful comments.

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Doll, S., Paccaud, F., Bovet, P. et al. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes 26, 48–57 (2002). https://doi.org/10.1038/sj.ijo.0801854

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