Diet, central obesity and prevalence of hypertension in the urban population of South India

BackgroundThis study aimed to uncover the changing prevalence of obesity and its association with hypertension across socioeconomic gradients in rural southwest China.MethodsData were collected from two cross-sectional health interviews and surveys from 2011 to 2021 among individuals aged ≥ 35 years in rural China. Each participant’s height, weight, waist circumference, and blood pressure were measured. The overall prevalence of obesity, central obesity, and hypertension was directly standardized by age based on the total population of the two surveys. Multivariate logistic regression was used to analyze the association between obesity and prevalence of hypertension and an individual socioeconomic position (SEP) index was constructed using principal component analysis.ResultsFrom 2011 to 2021, the prevalence of obesity, central obesity, and hypertension increased substantially, from 5.9%, 50.2%, and 26.1–12.1%, 58.0%, and 40.4% (P < 0.01), respectively. These increasing rates existed in all subcategories, including sex, age, ethnicity, education, annual household income, access to medical services, and SEP (P < 0.05). In both 2011 and 2021, lower education level and poor access to medical services correlated with higher prevalence of central obesity, while higher SEP correlated with higher prevalence of obesity and central obesity (P < 0.01). Prevalence of obesity was higher in the Han ethnicity participants and individuals with poor access to medical services than in their counterparts (P < 0.01). Whereas the prevalence of central obesity was lower in Han participants than in ethnic minority participants in 2011 (P < 0.01), this trend reversed in 2021 (P < 0.01). A positive relationship between annual household income and prevalence of obesity and central obesity was only found in 2021 (P < 0.01). Obese and centrally obese participants were more likely to be hypertensive in both survey years (P < 0.01).ConclusionsFuture interventions to prevent and manage obesity in rural China should give increased attention to high income, less educated, poor access to medical services, and high SEP individuals. The implementation of these obesity interventions would also help reduce the prevalence of hypertension.

In view of the rapid increase in the prevalence of coronary artery disease (CAD) in developing countries, our aim was to determine the prevalence of CAD and its risk factors and lifestyle factors in an elderly population from north India. A random sample of 595 elderly subjects between 50 to 84 years of age was obtained from the urban population of Moradabad. The response rate was 90.1%. The survey methods included a questionnaire containing information on 7-day food intake, other lifestyle factors, Rose questionnaire for diagnosis of angina pectoris, a standard 12-lead electrocardiogram, blood pressure measurements and blood examination. The total prevalence of CAD based on clinical history and electrocardiogram was 121/1000 (95% CI 72 to 165). The prevalence rate was slightly higher in males (130/1000) than in females (110/1000). The prevalence of CAD based on the Rose questionnaire was 57/1000 and based on electrocardiogram in 561 asymptomatic subjects was 67/1000. CAD was significantly higher in the elderly (65 to 84 years) group than in the middle-aged (50 to 64 years) group (168 vs. 97 per 1000), respectively. While the prevalence of hypertension was significantly higher in the elderly than middle-aged group respectively (214 vs. 168 per 1000), the prevalence of central obesity was significantly higher in the middle-aged than elderly group (674 vs. 632 per 1000). Other risk factors including smoking were comparable in the two subgroups. Prevalence of major risk factors and central obesity were significantly higher among patients with CAD than in the rest of the subjects. Prevalence of CAD was significantly higher in the middle and higher socio-economic groups compared to the lower income group. These higher income groups were also eating significantly higher amounts of visible fat and had a higher prevalence of physical inactivity (93.3%) compared to the lower income group. CAD and its risk factors such as hypertension, hypercholesterolemia, diabetes and central obesity are of sufficient magnitude in the elderly population of India to be a major public health problem. The findings also indicate that CAD is more commonly associated with middle and higher socio-economic status which may be due to greater consumption of dietary fat and more sedentariness compared to lower socioeconomic groups.

Analysis of Recent Papers in Hypertension

This cross-sectional study was conducted in the department of Bio-chemistry, Sylhet M.A.G Osmani Medical College, Sylhet during the period of 1st July 2008 to 30th June 2009. To find out the prevalence of central obesity, eight hundred fifty (850) medical students were selected from four medical colleges in Sylhet. Waist circumference (WC) &amp; waist hip ratio (WHR) were measured as an indes of central obesity Prevalence of central abdominal obesity among the students according to WC was 23.18% (In male &amp; female students 12.93% &amp; 33.81% respectively). Prevalence of central abdominal obesity according to WHR among the students was 35.88% (In male &amp; female students 28.40% &amp; 43.65% respectively). Key Words: Central obesity, WC, WHR

There is no universally accepted criterion for classification of overall weight status and central obesity in adolescents. Several criteria have been used which include that recommended by Centre for Disease control, World Health Organization and the International Obesity Task Force.Aim: The study compared various methods for determination of overall obesity in adolescents using the BMI percentiles recommended by the Centre for Disease Control (CDC), the International Obesity Task Force (IOTF) and the World Health Organization (WHO) BMI Z score and determination of central obesity using the waist circumference (WC), Waist Hip Ratio (WHR) and Waist Height Ratio (WHtR).Methods: The study subjects consisted of 1320 girls aged 10-19 years from randomly selected girl’s high school. Weight status to determine overall obesity was determined according to the CDC, IOTF and WHO criteria and central obesity determined using the WC, WHR, and WHtR. Comparison of methods was done and analysed.Results: Prevalence of overall and central obesity varied with different methods. The prevalence of overall obesity was 106(8.02%), 69(5.22%) and 39(2.75%) using the CDC, WHO and IOTF criteria respectively. Prevalence of central obesity was 1.5%, 16.26%, 47.81% using the WC, WHtR, and WHR respectively. The agreement between criteria of WHO Z score and BMI Percentile was highest for overall obesity. (K=0.81). There was a statistically significant association between overall weight status and central obesity using the different criteria of determination of central obesity.Conclusion: Prevalence of overall obesity and central obesity varied based on the methods used. The highest level of agreement for overall obesity determination was obtained between WHO Z score and BMI percentile compared to WHO Z score and IOTF criteria. Prevalence of central obesity increased significantly with overall obesity in study population.Key words: adolescents, Girls, overall and central obesity

BackgroundCardiovascular disease is a major public health problem in many sub-Saharan African countries, but data on the main cardiovascular risk factors–hypertension and obesity–are almost nonexistent in Senegal. The aims of this study were therefore (i) to report the prevalence, awareness, treatment and control of hypertension among adults in Dakar, (ii) to assess the prevalence of general and central obesity, and (iii) to analyze the association between hypertension and general and central obesity.MethodsA cross-sectional survey was carried out in 2015 on a representative sample of 1000 dwellers of the Senegalese capital aged 20–90.ResultsThe overall prevalence of hypertension was 24.7%. Among hypertensive respondents, 28.4% were aware of their condition; 16.0% were on antihypertensive medication; 4.9% had controlled blood pressure. The frequency of doctor visits was a significant predictor of awareness (OR = 2.16; p<0.05) and treatment (OR = 2.57; p<0.05) of hypertension. The prevalence of underweight, overweight and general obesity were 12.6%, 19.2% and 9.7% respectively. The prevalence of central obesity was 26% by WC and 39.8% by WHtR. General obesity and central obesity by WHtR significantly predicted HTN among men and women, but not central obesity by WC.ConclusionsThis study has demonstrated a high prevalence of hypertension in Dakar and a high prevalence of obesity among women–particularly among older women. The awareness, treatment, and effective control of hypertension are unacceptably low. The blood pressure of women with general obesity, and men with central obesity, in the community should be monitored regularly to limit the burden of cardiovascular disease in Senegal.

To study the relationship between prevalence of central obesity and clustering of cardiometabolic diseases among Chinese elder people over 60 years old. A complex multistage stratified sampling survey on chronic diseases was conducted in 162 surveillance points, 31 provinces, China in 2010 by China CDC. The survey included face-to-face interview, physical measurement (body height, weight, waist circumference (WC) and blood pressure) and laboratory test (blood sugar, blood lipid and hemoglobin A1C), to collect the information about the prevalence of the risk factors as smoking, drinking, diet and physical activities and the prevalence of hypertension, diabetes and dyslipidemia. The survey selected 19 966 subjects who were over 60 years old. Central obesity was defined as WC ≥ 85 cm in males or ≥ 80 cm in females. The prevalence of central obesity among the elder people over 60 years old in different districts and populations was calculated; and the proportion of cardiometabolic diseases in groups of different WC was then analyzed. The prevalence of central obesity among elderly population over 60 years old was 48.6% (95%CI:46.1%-51.2%), including 39.7% (95%CI:37.2%-42.2%) males and 57.3% (95%CI:54.5%-60.1%) females. The proportion of females was higher than that of males (χ(2) = 474.63, P < 0.01). The higher the education level, the higher the prevalence of central obesity among elderly men. There was no significant association among females. The higher the family income, the higher the prevalence of central obesity. The prevalence of central obesity was 59.2% in urban area, which was much higher than that in rural area (43.5%) (χ(2) = 50.06, P < 0.01). The proportion of hypertension, diabetes and clustering of cardiometabolic disease was separately 18.8% (95%CI:16.1%-21.5%) , 66.2% (95%CI:63.0%-69.4%) and 47.5% (95%CI:44.1%-50.8%) among elderly men with WC between 85 and 89 cm, and separately 24.0% (95%CI:21.2%-26.8%), 78.2% (95%CI:75.6%-80.8%) and 64.0% (95%CI:60.3%-67.6%) among elderly men with WC ≥ 90 cm; which were both higher than those among elderly men with WC < 85 cm (separately 13.4% (95%CI:11.5%-15.3%) , 58.3% ( 95%CI:55.5%-60.1%) and 30.8% (95%CI:28.7%-32.9%) ). The proportion of hypertension, diabetes and clustering of cardiometabolic disease was 20.1% (95%CI:17.4%-22.7%) , 68.6% (95%CI:65.5%-71.8%) and 48.1% (95%CI:44.6%-51.6%) among elderly women with WC between 80 and 84 cm, and separately 31.7% (95%CI:28.9%-34.4%) , 81.0% (95%CI:78.5%-83.5%) and 61.8% (95%CI:58.9%-64.8%) among elderly women with WC ≥ 85 cm; which were both higher than those among elderly women with WC < 80 cm (separately 12.8% (95%CI:10.8%-14.8%) , 60.1% (95%CI:57.1%-63.0%) and 30.4% (95%CI:27.3%-33.5%)). Nearly half of the Chinese elder people were central obese. The proportion of cardiometabolic diseases among central obesity was significantly higher than that among non-obese population. We should pay more concern about them in the future prevention and control of chronic diseases.

To determine age-specific prevalence of hypertension and blood pressure (BP) levels in relation to diet and lifestyle factors in North Indians. Cross-sectional survey in 20 randomly selected streets in Moradabad, North India. A total of 1806 subjects from North India (904 males and 902 females) age range 25-64 years. The survey methods were as follows: dietary diaries for 7 days food intake record; BP measurements; physician administered questionnaire and anthropometric measurements. Diagnosis of hypertension was based on new World Health Organization/International Society of Hypertension (WHO/ISH) criteria. Risk factors were assessed based on WHO guidelines. The prevalence of hypertension according to WHO/ISH criteria was 23.7% and by old WHO criteria 13.3%. In the WHO/ISH hypertensive group, isolated diastolic hypertension was present in 47.3% males and 40.6% females. Males have a slightly higher prevalence than females in the young age group, however, the prevalence rates are comparable in the older age groups. In both sexes, the prevalence rates and BP level increased with older age. Multivariate analysis revealed that age, higher body mass index, central obesity and higher socioeconomic status were independently and strongly associated with hypertension in both sexes. Higher dietary fat and salt intake and lower physical activity were weakly but significantly associated with hypertension. Association of higher socioeconmic status, higher body mass index and central obesity in North Indian adults with higher fat intake, lower physical activity and higher prevalence and level of hypertension indicate that these populations may benefit by decreasing the dietary fat intake and increasing physical activity, with an aim to decrease central obesity for decreasing hypertension in North Indians.

Despite the extensive evidence from epidemiological studies showing that hypertension is a major risk factor for premature cardiovascular morbidity and mortality and from randomized clinical trials showing that this risk can be markedly reduced by antihypertensive drug therapy, hypertension is generally considered to be poorly managed. Surveys performed in the 1990s reported low rates for awareness, treatment, and control of hypertension. Since better once-daily antihypertensive drugs with less adverse effects have become available and both healthcare providers and the general public appear to place more emphasis on prevention of cardiovascular disease, one may expect these advances to translate not only into more awareness of the presence of hypertension but also into better treatment and control rates. Indeed, successive reports from National Health and Nutrition Examination Survey (NHANES) reported progressive improvement in awareness, treatment, and control rates, up to 80.7%, 72.5%, and 50.1%, respectively, for the 2007–2008 survey.1 Two recent Canadian surveys reported even more substantial improvements in treatment and control rates in the general hypertension population. First, a survey in Ontario, the largest province of Canada, with an adult population of ≈8 million, reported 86.3% awareness, 80.5% treatment, and 65.7% control rates.2 Then, a Canada-wide survey provided similar high rates: 83.4,% 79.9,% and 65.9% for awareness, treatment, and control rates for adults with hypertension, 20 to 79 years of age.3 These rates are only 10% to 25% below the “optimal” rates that one may expect in a cross-sectional survey. The results from NHANES and …

Over the past few decades there has been an increase in the central or abdominal obesity. Endothelial dysfunction, insulin resistance with metabolic syndrome and a higher cardiometabolic risk are directly linked to abdominal obesity. A better understanding of the epidemiology of obesity would provide insights to its mitigation. This cross sectional study was designed to identify Central obesity, General obesity and Normal Weight central obesity among young adults using the following surrogate markers Waist circumference (WC), Waist hip ratio (WHR), Waist height ratio (WtHR) and BMI. After due informed written consent, 300 young adults with equal representation of both sexes (150 each) studying MBBS, Dentistry and Physiotherapy stream in a private university were selected. Various anthropometric measures like weight, hip circumference and waist circumference and height were measured according to WHO STEPS instrument. BMI based on Asia- Pacific cut -off values was used to define general obesity. Central obesity was defined by a Waist Circumference of  80 cm in females and  90 cm in male’s .For waist to height ratio a value of  0.5 in both genders was used. For waist to hip ratio the cut off value used was 0.85 in females and 0.90 in males. An individual with normal weight according to BMI but having central obesity fits into Normal Weight Central obesity category. Average age of the participants was 20.6 1.31 years. General Obesity was more among males with 46% prevalence as compared to 25.33%among females. In contrast, the prevalence of central obesity was more among females. The prevalence of Normal weight central obesity was more among females, varying from 4% to 17% using different types of anthropometric measures for central obesity. A high positive correlation was observed between BMI with WC, WtHR and WHR. (p=0.0001) Current practice of taking only BMI into consideration for defining obesity in our country needs serious re-evaluation considering the increasing prevalence of abdominal obesity and its long term impact.

Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level. To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population. PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology). Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions. Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend. Prevalence of childhood hypertension overall and by subgroup. A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years. This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.

Objectives: This study assessed the prevalence of central overweight and obesity in students of the University for Development Studies in Tamale, Ghana. Lifestyle factors associated with central overweight and obesity were also investigated in this study population.Design: A cross-sectional study design was employed.Setting: School of Medicine and Health Sciences, University for Development Studies, Tamale, Ghana.Subjects: A sample of 552 students was randomly selected to participate.Method: Waist and hip circumference was measured with appropriate tools and computed into a waist-to-hip ratio (WHR). Demographic and socio-cultural factors, such as age, sex, smoking status and coffee and alcohol consumption, were recorded. Physical activity was assessed using the World Health Organization Global Physical Activity Questionnaire.Results: Generally, 29.3% of the participants had a normal WHR (44.1% males, 3.0% females). 60.9% (55.9% males, 69.7% females) were centrally overweight and 9.8% (0.0% males, 27.3% females) centrally obese. Age and smoking status were not associated with central overweight and obesity. Being female was significantly associated with a higher prevalence of central obesity. The prevalence of central obesity was 13.9% in non-coffee drinkers, 6.7% in coffee drinkers, 11% in non-alcohol drinkers and 0% in alcohol drinkers. Almost 95% of centrally obese participants engaged in light or moderate physical activity, and 5.6% in vigorous physical activity (p-value < 0.0001). Conversely, 55% of normal weight participants engaged in light or moderate physical activity and 44% in vigorous physical activity (p-value 0.0008).Conclusion: Physical activity, female gender, alcohol and coffee consumption were associated with central obesity.

Objective: To understand the prevalence, awareness, treatment and control of hypertension in elderly residents in Hebei province. Methods: Elderly residents aged ≥60 were selected though multistage clustering sampling during August to December, 2015. Design based methods were adopted to analyze the prevalence, awareness, treatment and control of hypertension in local residents of Hebei. Results: A total of 2 501 elderly adults were included in the study. The overall prevalence rate of hypertension was 63.7% (58.3% in males, 69.0% in females), the awareness rate of hypertension was 42.4% (35.7% in males, 48.0% in females), the treatment rate was 38.2% (32.0% in males, 43.3% in females), and the control rate was 9.0% (8.1% in males, 9.7% in females). The results of multivariate analysis indicated that age, sex, degree of education, BMI and central obesity were the factors influencing the prevalence, awareness, treatment and control of hypertension in elderly population in Hebei. Conclusions: The prevalence of hypertension was high, but the rates of awareness, treatment and control of hypertension were low in elderly residents in Hebei. The influences of overweight, obesity and central obesity on hypertension were significant in the elderly. It is necessary to standard the management of hypertension and reduce the risk factors for hypertension in elderly population to improve the control of hypertension.

Objective: To investigate the prevalence of hypertension and risk factors in Uygur adults in Kashgar of Xinjiang. Methods: A total of 4 748 Uygur adults aged ≥18 years selected through cluster random sampling in Shufu county of Kashgar prefecture were surveyed by means of questionnaire survey, physical examination and laboratory test. The prevalence, awareness, treatment and control rate of hypertension of different groups were calculated and risk factors of hypertension was analyzed by using non-conditional logistic regression model. Results: The overall prevalence of hypertension was 15.73% (age-adjusted prevalence was 13.75%). The prevalence rates of hypertension in men and women were 16.36% (age-adjusted prevalence was 12.96%), 15.39% (age-adjusted prevalence was 14.34%), respectively. The rates of awareness, treatment and control of hypertension were 59.57%, 52.74%, 21.29%, respectively. The prevalence of hypertension increased with age. Compared with age group 18-34 years, the age groups 55-64, ≥65 years had higher risk of hypertension and the OR values were 10.53, 20.96 for men and 16.27, 33.20 for women. The overweight (OR=1.47 for men, OR=1.82 for women, P<0.05) and obesity (OR=1.88 for men, OR=2.66 for women, P<0.05) also increased the risk of hypertension. The groups with family history of hypertension (OR=3.85 for men, OR=2.34 for women, P<0.05) also had higher risk of hypertension. Hypertriglyceridemia was positively correlated with the prevalence of hypertension in men (OR=1.62, 95%CI: 1.09-2.41). Conclusions: The prevalence of hypertension in Uygur adults in Kashgar area of Xinjiang was at relatively low level. The related risk factors were age, overweight, obesity, family history and hypertriglyceridemia in men and the risk factors were similar in women except hypertriglyceridemia.

Diabetes and hypertension are the most prevalent morbidities in India and are quickly becoming common among the younger age groups. Adolescents aged 10-19 years, accounting for one-fifth of the country's population, are at an increasing risk of developing these conditions. We aim to examine the prevalence, awareness, treatment, and control (ATC) of diabetes and hypertension among late adolescents (15-19 years) in India. We used microdata of 204 346 late adolescents from India's fifth round of the National Family and Health Survey, 2019-21. We defined hypertensive adolescents as those diagnosed with hypertension or those with a systolic blood pressure (BP) measurement of ≥130 mm Hg, diastolic BP measurements of levels ≥80 mm Hg, or those who used medication to lower BP at the time of the survey. Diabetic adolescents were those diagnosed as such by health professionals, those with glucose levels above 140 mg/dL, or those taking any medication to control high blood glucose levels at the time of the survey. We estimated the age-sex-adjusted prevalence of both conditions and their ATC rates, referred to as cascade care. We used the Erreygers' Concentration Index to examine the socioeconomic inequality in cascade care. We used multivariable logistic regression to estimate the average marginal effects while controlling for sociodemographic characteristics. Of 204 346 late adolescents, 27.8% (95% confidence interval (CI) = 27.6, 28.2) had either of the two conditions, with 3.5% (95% CI = 3.4, 3.6) being diabetic and 24.3% (95% CI = 24.0, 24.6) having hypertension. The ATC rate of diabetes was 13.5% (95% CI = 12.4, 14.7), 13.1% (95% CI = 11.9, 14.2), and 12.1% (95% CI = 11.0, 13.3), respectively. For hypertension, the ATC rate was extremely low at 6.2% (95% CI = 5.8, 6.5), 3.5% (95% CI = 3.3, 3.7), and 3.3% (95% CI = 3.1, 3.5), respectively. There was a pro-rich socioeconomic inequality in the prevalence of hypertension and a pro-poor inequality in the prevalence of diabetes among late adolescents. We observed significant variations in both conditions across the regions of India. The high prevalence and low care cascade levels of diabetes and hypertension among late adolescents in India are concerning. A multipronged strategy that includes screening, diagnosis, and timely interventions at school and home can reduce the burden of hypertension and diabetes among the prospective workforce in India. Sensitising adolescents through school curricula under the New Education Policy (2020) is recommended to reduce the burden of these conditions. We also recommend that longitudinal and intervention studies focussed on this age group be undertaken in the future to help reduce the disease burden.