Abstract
Overweight and obesity are growing worldwide and strongly associated with hypertension. The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index is proposed as an optimal indicator of body fatness. We aimed to investigate the association of body fat as captured by the CUN-BAE index with incident hypertension in a Mediterranean population. We assessed 15,950 participants of the SUN (Seguimiento Universidad de Navarra) prospective cohort (63.7% women) initially free of hypertension. Participants completed follow-up questionnaires biennially. A validated 136-item food-frequency questionnaire was administered at baseline. We used Cox models adjusted for multiple confounders. Among 12.3 years of median follow-up (interquartile range: 8.3, 15.0 years), 2160 participants reported having received a diagnosis of hypertension. We observed a strong direct association between progressively higher the CUN-BAE index at baseline and incident hypertension during follow-up in multivariable-adjusted models for men and women, even after further adjustment for BMI ≥ 30 kg/m2, showing a significant association also in non-obese participants. For each 2-unit increase in the CUN-BAE index, hypertension risk increased by 27% and 29% in men and women, respectively. The results remained significant when considering longitudinal repeated measures of changes in body fat assessed with the CUN-BAE index among the different biennial follow-up questionnaires. Our results emphasize the importance of reducing and maintaining a low body fat to prevent hypertension.
Highlights
Data from 195 countries worldwide of the Global Burden of Disease study assessing the trends in the prevalence of overweight and obesity among adults and children between 1980 and 2015 showed that 107.7 million children and 603.7 million adults were obese in 2015 with a twofold increased prevalence since 1980 in over 70 countries and a continuous rise in most other countries [1]
The present results from analyses on data of the SUN Project, a well-characterized, prospective, and large cohort of Spanish university graduates, showed that body fat as captured by the Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index was positively and strongly associated with incident hypertension after a long-term follow-up, independently of numerous potential confounders that were considered in the fully-adjusted multivariable models
The risk of incident hypertension was independently associated with the CUN-BAE-estimated body fat even after adjusting for obesity considering the classical cut-off point of body mass index (BMI) of 30 kg/m2, which suggests that progressively higher adiposity is independent of being obese for longterm incidence of hypertension
Summary
Data from 195 countries worldwide of the Global Burden of Disease study assessing the trends in the prevalence of overweight and obesity among adults and children between 1980 and 2015 showed that 107.7 million children and 603.7 million adults were obese in 2015 with a twofold increased prevalence since 1980 in over 70 countries and a continuous rise in most other countries [1]. Obesity prevalence, which continues to rise, represents a major health and economic burden [2]. The relationship of obesity and hypertension has been well defined in adults and children across both men and women [3,8]. 78% of incident hypertension in men and 65% in women were attributable to excess body fat in the Framingham Offspring Study [9]. A 5% increase in body weight was associated with 20% to
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