Abstract
This study investigated the relationship between obesity and hypertension from a public health perspective in a small remote island of Okinawa where obesity is prevalent. A cross-sectional study was conducted in 456 residents aged ≥18 years in Yonaguni island who underwent an annual health check-up and the Yonaguni dietary survey in 2022. Each participant responded to our original questionnaire and provided further dietary survey data via the Yonaguni municipal government. The odds ratio for hypertension was calculated in the obese group, using a logistic regression model with the non-obese group serving as the reference. Hypertension was defined as a systolic blood pressure ≥140 mmHg, a diastolic blood pressure ≥90 mmHg measured on an automated sphygmomanometer, and/or taking anti-hypertensive agents, while obesity was defined as a body mass index ≥25 kg/m2. The proportion of hypertension associated with obesity among all hypertensive subjects was calculated. The prevalence of obesity and hypertension was 54.3% and 49.0% in the 208 male subjects and 32.3% and 43.6% in the 248 female subjects, respectively. The odds ratio for hypertension in the obese group was 3.73 (95% confidence interval, 1.93–7.20) for men and 4.13 (2.06-8.29) for women after adjusting for age, alcohol drinking habit, behavior for lowering salt intake, and smoking habit. Hypertension in 49.5% (95% confidence interval, 29.4%-63.9%) of males and 37.9% (22.6%–50.2%) of females was associated with obesity in this island. Some areas of Japan could be urgently required to address obesity for preventing cardiovascular disease.
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References
Asia Pacific Cohort Studies Collaboration. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens. 2003;21:707–16.
Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa SY, Okamura T, et al. Observational Cohorts in Japan (EPOCH-JAPAN) Research Group. Blood pressure categories and long-term risk of cardiovascular disease according to age group in Japanese men and women. Hypertens Res. 2012;35:947–53.
Ikeda N, Inoue M, Iso H, Ikeda S, Satoh T, Noda M, et al. Adult mortality attributable to preventable risk factors for non-communicable diseases and injuries in Japan: a comparative risk assessment. PLoS Med. 2012;9:e1001160.
Hozawa A, Okamura T, Murakami Y, Kadowaki T, Nakamura K, Hayakawa T, et al. Joint impact of smoking and hypertension on cardiovascular disease and all-cause mortality in Japan: NIPPON DATA80, a 19-year follow-up. Hypertens Res. 2007;30:1169–75.
Nakamura K, Nakagawa H, Sakurai M, Murakami Y, Irie F, Fujiyoshi A, et al. Influence of smoking combined with another risk factor on the risk of mortality from coronary heart disease and stroke: pooled analysis of 10 Japanese cohort studies. Cerebrovasc Dis. 2012;33:480–91.
Yamamoto T, Nakamura Y, Hozawa A, Okamura T, Kadowaki T, Hayakawa T, et al. Low-risk profile for cardiovascular disease and mortality in Japanese. Circ J. 2008;72:545–50.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.
Ueshima H, Tatara K, Asakura S, Okamoto M. Declining trends in blood pressure level and the prevalence of hypertension, and changes in related factors in Japan, 1956-1980. J Chronic Dis. 1987;40:137–47.
Ministry of Health, Labour and Welfare, Japan. The National Health and Nutrition survey in Japan. https://www.mhlw.go.jp/bunya/kenkou/kenkou_eiyou_chousa.html Accessed 14 December 2022 [in Japanese].
Shams E, Kamalumpundi V, Peterson J, Gismondi RA, Oigman W, de Gusmão, et al. Highlights of mechanisms and treatment of obesity-related hypertension. J Hum Hypertens. 2022;36:785–93.
Nakamura K, Okamura T, Hayakawa T, Hozawa A, Kadowaki T, Murakami Y, et al. NIPPON DATA80, 90 Research Group. The proportion of individuals with obesity-induced hypertension among total hypertensives in a general Japanese population: NIPPON DATA80, 90. Eur J Epidemiol. 2007;22:691–8.
Okinawa Prefecture. The Specific Health Checkup (Examination and Questionnaire). Konko Okinawa 21. http://www.kenko-okinawa21.jp/090-docs/2021031800016/ Accessed 14 December 2022 [in Japanese].
World Health Organization. Obesity. Preventing and Managing the Global Endemic. WHO Technical Report Series no 894. WHO: Geneva, Switzerland, 2000.
The Examination Committee of Criteria for ‘Obesity Disease’ in Japan, Japan Society for the study of Obesity. New criteria for ‘obesity disease’ in Japan. Circ J. 2002;66:987–92.
Sugahara A, Toyokawa H. A Study of Dietary Condition and Food Distribution System in the Islands. Report (1) Yonaguni Island. Jpn J Health & Human Ecology. 1979;45:104–13.
Miquel Porta. A Dictionary of Epidemiology, 6th edn. Oxford University Press: New York, NY, USA, 2014.
Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15–9.
Greenland S. Re: “Confidence limits made easy: interval estimation using a substitution method”. Am J Epidemiol. 1999;149:884–6.
Nakamura T, Nakamura Y, Saitoh S, Okamura T, Yanagita M, Yoshita K, et al. Relationship Between Socioeconomic Status and the Prevalence of Underweight, Overweight or Obesity in a General Japanese Population: NIPPON DATA2010. J Epidemiol. 2018;28:S10–6.
Nakanishi N, Nakamura K, Ichikawa S, Suzuki K, Tatara K. Lifestyle and the development of hypertension: a 3-year follow-up study of middle-aged Japanese male office workers. Occup Med. 1999;49:109–14.
Kadota A, Okuda N, Ohkubo T, Okamura T, Nishi N, Ueshima H, et al. The National Integrated Project for Prospective Observation of Non-communicable Disease and its Trends in the Aged 2010 (NIPPON DATA2010): Objectives, Design, and Population Characteristics. J Epidemiol. 2018;28:S2–9.
Nakamura K, Okamura T, Hayakawa T, Hozawa A, Kadowaki T, Murakami Y, et al. NIPPON DATA90 Research Group. The proportion of individuals with alcohol-induced hypertension among total hypertensives in a general Japanese population: NIPPON DATA90. Hypertens Res. 2007;30:663–8.
Dong G, Sun Z, Zheng L, Li J, Zhang X, Zhang X, et al. Prevalence, awareness, treatment, and control of hypertension in rural adults from Liaoning Province, northeast China. Hypertens Res. 2007;30:951–8.
Dong C, Ge P, Ren X, Fan H, Yan X. Prevalence, awareness, treatment and control of hypertension among adults in rural north-western China: a cross-sectional population survey. J Int Med Res. 2013;41:1291–300.
Tian S, Dong GH, Wang D, Liu MM, Lin Q, Meng XJ, et al. Factors associated with prevalence, awareness, treatment and control of hypertension in urban adults from 33 communities in China: the CHPSNE Study. Hypertens Res. 2011;34:1087–92.
Choi HM, Kim HC, Kang DR. Sex differences in hypertension prevalence and control: Analysis of the 2010-2014 Korea National Health and Nutrition Examination Survey. PLoS One. 2017;12:e0178334.
Moser KA, Agrawal S, Davey Smith G, Ebrahim S. Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: analysis of nationally-representative survey data. PLoS One. 2014;9:e86043.
Quoc Cuong T, Van Bao L, Anh Tuan N, Van Thang V, Minh Quan N, Yang SH, et al. Associated Factors of Hypertension in Women and Men in Vietnam: A Cross-Sectional Study. Int J Environ Res Public Health. 2019;16:4714.
Bjertness MB, Htet AS, Meyer HE, Htike MM, Zaw KK, Oo WM, et al. Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study. BMC Public Health. 2016;16:590.
Brown CD, Higgins M, Donato KA, Rohde FC, Garrison R, Obarzanek E, et al. Body mass index and the prevalence of hypertension and dyslipidemia. Obes Res. 2000;8:605–19.
Landi F, Calvani R, Picca A, Tosato M, Martone AM, Ortolani E, et al. Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study. Nutrients. 2018;10:1976.
Acknowledgements
We express special gratitude to all the study participants, the Yonaguni municipal government officers, and other individuals who were involved in the Yonaguni island study.
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All authors conceived and were involved in the design of the study, data acquisition, statistical analysis, interpretation of the results, and wrote the manuscript. KN supervised the study.
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Fukumine, Y., Nakamura, K. Obesity and hypertension from a public health perspective in a small remote island of Okinawa, Japan. Hypertens Res 46, 1850–1859 (2023). https://doi.org/10.1038/s41440-023-01293-z
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DOI: https://doi.org/10.1038/s41440-023-01293-z
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