Epidemiology and Prevention Unit, Stroke and Ageing Research, Department of Medicine, Southern Clinical School, Monash University, Melbourne, Australia,
Eur J Epidemiol. 2014 May;29(5):311-24. doi: 10.1007/s10654-014-9911-6. Epub 2014 May 17.
More than 75 % of people with hypertension live in low-to-middle income countries (LMICs). Based on the mismatch theory of developmental origins of disease, we hypothesised that the impact of adiposity on hypertension is augmented in lean compared with not-lean populations in rural areas of LMICs (RLMICs). We reviewed studies from RLMICs in which the association between body mass index (BMI) or waist circumference (WC) and hypertension was assessed using multivariable models. Applying random effect models, we conducted separate meta-analyses, depending on whether BMI/WC was assessed as a continuous or categorical variable. In each analysis, the studies were ranked by the mean BMI of the total population. Those populations with a mean BMI below the median were categorised as lean and those above the median as not-lean. We identified 46 studies of BMI and 12 of WC. The risk of hypertension was greater in lean than in not-lean populations. Obese males in lean populations were 45 % more likely to be hypertensive compared to obese males in not-lean populations, ratio of the two effect sizes: 1.45 (95 % CI 1.04, 2.03), p = 0.027. Also, individuals with WC above normal in lean populations were 52 % more likely to be hypertensive than their counterparts in not-lean populations, ratio of the two effect sizes: 1.52 (95 % CI 1.06, 2.17), p = 0.021. We conclude that the risk of hypertension associated with adiposity is greater in lean than in not-lean populations. This provides further evidence for the mismatch theory and highlights the need for strategies to improve nutrition in disadvantaged RLMICs.
超过 75%的高血压患者生活在中低收入国家（LMICs）。基于疾病发生的发育起源不匹配理论，我们假设在农村地区的 LMICs（RLMICs）中，与非消瘦人群相比，肥胖对高血压的影响在消瘦人群中更为明显。我们对来自 RLMICs 的研究进行了综述，这些研究使用多变量模型评估了体重指数（BMI）或腰围（WC）与高血压之间的关系。我们应用随机效应模型，根据 BMI/WC 是作为连续变量还是分类变量进行了单独的荟萃分析。在每种分析中，根据总人群的平均 BMI 对研究进行排名。那些平均 BMI 低于中位数的人群被归类为消瘦人群，而高于中位数的人群被归类为非消瘦人群。我们确定了 46 项 BMI 研究和 12 项 WC 研究。在消瘦人群中，高血压的风险高于非消瘦人群。与非消瘦人群中的肥胖男性相比，消瘦人群中的肥胖男性患高血压的可能性高 45%，两个效应大小的比值为 1.45（95%CI 1.04，2.03），p = 0.027。此外，在消瘦人群中，WC 高于正常值的个体患高血压的可能性比非消瘦人群中的个体高 52%，两个效应大小的比值为 1.52（95%CI 1.06，2.17），p = 0.021。我们得出结论，与肥胖相关的高血压风险在消瘦人群中比在非消瘦人群中更高。这为不匹配理论提供了进一步的证据，并强调了在贫困的 RLMICs 中改善营养的策略的必要性。
