Kabootari Maryam, Akbarpour Samaneh, Azizi Fereidoun, Hadaegh Farzad
1Metabolic Disorders Research Center, Golestan university of Medical Sciences, Gorgan, Iran.
2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, No. 24, Parvaneh Street, Velenjak, Tehran, Iran.
Nutr Metab (Lond). 2019 Feb 27;16:16. doi: 10.1186/s12986-019-0340-0. eCollection 2019.
To investigate the association between different obesity phenotypes and the risk of incident hypertension among both genders.
The study population included 3659 Iranians (me = 1540), aged ≥20 years free of hypertension at baseline. Participant were classified into six categories of body mass index (BMI)-metabolic health status, in which unhealthy metabolic status was defined based on the presence of > 1 component of metabolic syndrome (MetS) using the joint interim statement (JIS) criteria or the presence of insulin resistance (IR). The association between different obesity phenotypes and incident hypertension was assessed using multivariate Cox's proportional hazard models adjusted for age, current smoking, low physical activity, diabetes mellitus, family history of premature cardiovascular disease, estimated glomerular filtration rate, phase of recruitment, BMI and systolic blood pressure, considering metabolically healthy normal weight group as the reference.
After a median follow-up of 11.6 years 1122 participants (men = 493) experienced hypertension. Using JIS criteria, a significant higher risk of hypertension was observed among metabolically healthy obese and well as metabolically unhealthy groups among men in the age adjusted model; however, a significant higher risk in the fully adjusted model was seen among women in the metabolically healthy obese [hazard ratio (HR) 95% confidence interval (CI) 1.96(1.16-3.32)] as well as metabolically unhealthy normal weight [1.98(1.37-2.86)], overweight [2.08(1.49-2.90)] and obese [2.06(1.27-3.30)] groups. Using insulin sensitive normal weight group as the reference, among men, being overweight or obese with and without IR was significant predictors of incident hypertension in the age adjusted model; however, among women, insulin resistant overweight [1.46(1.06-2.02)] and obese groups, [1.63(1.01-2.62)] showed significant risk in the fully adjusted model.
We concluded that first, there was significant difference between genders in the associations between obesity phenotypes and incident hypertension. Second, in general, metabolic status defined by MetS components as compared to IR could do better in identifying high risk women for hypertension. Third, women populations who are metabolically healthy obese using MetS definition or those with either > 1 component of metabolic syndrome or overweight/obese ones with IR should be prioritized for implementing urgent preventive strategies against hypertension focusing on lifestyle changes.
探讨不同肥胖表型与男女新发高血压风险之间的关联。
研究人群包括3659名伊朗人（男性 = 1540名），年龄≥20岁，基线时无高血压。参与者被分为六类体重指数（BMI）-代谢健康状态，其中不健康的代谢状态根据代谢综合征（MetS）> 1项组分的存在情况，采用联合临时声明（JIS）标准或胰岛素抵抗（IR）的存在情况来定义。使用多变量Cox比例风险模型评估不同肥胖表型与新发高血压之间的关联，并对年龄、当前吸烟状况、低体力活动、糖尿病、心血管疾病早发家族史、估计肾小球滤过率、招募阶段、BMI和收缩压进行调整，将代谢健康的正常体重组作为参照。
在中位随访11.6年后，1122名参与者（男性 = 493名）发生了高血压。采用JIS标准，在年龄调整模型中，男性代谢健康肥胖组以及代谢不健康组中高血压风险显著更高；然而，在完全调整模型中，代谢健康肥胖的女性[风险比（HR）95%置信区间（CI）1.96（1.16 - 3.32）]以及代谢不健康的正常体重女性[1.98（1.37 - 2.86）]、超重女性[2.08（1.49 - 2.90）]和肥胖女性[2.06（1.27 - 3.30）]组中高血压风险显著更高。以胰岛素敏感的正常体重组作为参照，在年龄调整模型中，男性超重或肥胖且伴有或不伴有IR是新发高血压的显著预测因素；然而，在完全调整模型中，女性胰岛素抵抗的超重[1.46（1.06 - 2.02）]和肥胖组[1.63（1.01 - 2.62）]显示出显著风险。
我们得出结论，第一，肥胖表型与新发高血压之间的关联在男女之间存在显著差异。第二，总体而言，与IR相比，由MetS组分定义的代谢状态在识别高血压高危女性方面表现更好。第三，对于采用MetS定义的代谢健康肥胖女性人群，或具有> 1项代谢综合征组分的女性人群，以及伴有IR的超重/肥胖女性人群，应优先实施针对高血压的紧急预防策略，重点是改变生活方式。
