Abstract
Background: Greater adiposity is associated with higher blood pressure. Substantial uncertainty remains, however, about which measures of adiposity most strongly predict blood pressure and whether these associations differ materially between populations.Methods: We examined cross-sectional data on 500 000 adults recruited from 10 diverse localities across China during 2004–08. Multiple linear regression was used to estimate the effects on systolic blood pressure (SBP) of general adiposity [e.g. body mass index (BMI), body fat percentage, height-adjusted weight] vs central adiposity [e.g. waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR)], before and after adjustment for each other. The main analyses excluded those reported taking any antihypertensive medication, and were adjusted for age, region and education.Results: The overall mean [standard deviation (SD)] BMI was 23.6 (3.3) kg/m2 and mean WC was 80.0 (9.5) cm. The differences in SBP (men/women, mmHg) per 1SD higher general adiposity (height-adjusted weight: 6.6/5.6; BMI: 5.5/4.9; body fat percentage: 5.5/5.0) were greater than for central adiposity (WC: 5.0/4.3; HC: 4.8/4.1; WHR: 3.7/3.2), with a 10 kg/m2 greater BMI being associated on average with 16 (men/women: 17/14) mmHg higher SBP. The associations of blood pressure with measures of general adiposity were not materially altered by adjusting for WC and HC, but those for central adiposity were significantly attenuated after adjusting for BMI (WC: 1.1/0.7; HC: 0.3/−0.2; WHR: 0.6/0.6).Conclusion: In adult Chinese, blood pressure is more strongly associated with general adiposity than with central adiposity, and the associations with BMI were about 50% stronger than those observed in Western populations.
Highlights
Controlled trials of weight loss interventions[1,2] and Mendelian randomization studies of blood pressure in relation to adiposity-related genetic variants[3,4] have both established the causal association between adiposity and blood pressure
We examine the associations of blood pressure with several different measures of adiposity among 500 000 adults in the China Kadoorie Biobank (CKB) study.[33,34]
Body fat percentage showed similar patterns with age, and the mean levels were greater in women (32.0%) than in men (21.9%) and likewise the absolute fat mass was greater in women than in men (7.8 vs 5.3 kg), despite women weighing on average about 7.5 kg less
Summary
Controlled trials of weight loss interventions[1,2] and Mendelian randomization studies of blood pressure in relation to adiposity-related genetic variants[3,4] have both established the causal association between adiposity and blood pressure. In Western adult populations, a 10 kg/m2 higher body mass index (BMI) is associated with $10 mmHg higher systolic blood pressure (SBP), throughout the range typically found in Western populations.[5] there is little reliable evidence about whether these associations differ materially by age, sex or other personal characteristics. Multiple linear regression was used to estimate the effects on systolic blood pressure (SBP) of general adiposity [e.g. body mass index (BMI), body fat percentage, height-adjusted weight] vs central adiposity [e.g. waist circumference (WC), hip circumference (HC), waist-hip ratio (WHR)], before and after adjustment for each other. The differences in SBP (men/women, mmHg) per 1SD higher general adiposity (height-adjusted weight: 6.6/5.6; BMI: 5.5/4.9; body fat percentage: 5.5/5.0) were greater than for central adiposity (WC: 5.0/4.3; HC: 4.8/4.1; WHR: 3.7/3.2), with a 10 kg/m2 greater BMI being associated on average with 16 (men/women: 17/14) mmHg higher SBP. The associations of blood pressure with measures of general adiposity were
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