Articles15 June 2004
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    Abstract

    Background:

    Visceral adiposity is generally considered to play a key role in the metabolic syndrome.

    Objective:

    To examine the relationship between directly measured visceral adiposity and the risk for incident hypertension, independent of other adipose depots and fasting plasma insulin levels.

    Design:

    Community-based prospective cohort study with 10- to 11-year follow-up.

    Setting:

    King County, Washington.

    Participants:

    300 Japanese Americans with a systolic blood pressure less than 140 mm Hg and a diastolic blood pressure less than 90 mm Hg who were not taking antihypertensive medications, oral hypoglycemic medications, or insulin at study entry.

    Measurements:

    Abdominal, thoracic, and thigh fat areas were measured by using computed tomography. Total subcutaneous fat area was calculated as the sum of these fat areas excluding the intra-abdominal fat area. Hypertension during follow-up was defined as having a systolic blood pressure of 140 mm Hg or greater, having a diastolic blood pressure of 90 mm Hg or greater, or taking antihypertensive medications.

    Results:

    There were 92 incident cases of hypertension during the follow-up period. The intra-abdominal fat area was associated with an increased risk for hypertension. Multiple-adjusted odds ratios of hypertension for quartiles of intra-abdominal fat area (1 = lowest; 4 = highest) were 5.07 (95% CI, 1.75 to 14.73) for quartile 3 and 3.48 (CI, 1.01 to 11.99) for quartile 4 compared with quartile 1 after adjustment for age, sex, fasting plasma insulin level, 2-hour plasma glucose level, body mass index, systolic blood pressure, alcohol consumption, smoking status, and energy expenditure through exercise (P = 0.003 for quadratic trend). The intra-abdominal fat area remained a significant risk factor for hypertension, even after adjustment for total subcutaneous fat area, abdominal subcutaneous fat area, or waist circumference; however, no measure of these fat areas was associated with risk for hypertension in models that contained the intra-abdominal fat area.

    Limitations:

    It is not known whether these results pertain to other ethnic groups.

    Conclusions:

    Greater visceral adiposity increases the risk for hypertension in Japanese Americans.

    References

    • 1. Kaplan NMThe deadly quartet. Upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med1989;149:1514-20. [PMID: 2662932] CrossrefMedlineGoogle Scholar
    • 2. Despres JPMoorjani SLupien PJTremblay ANadeau ABouchard CRegional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis1990;10:497-511. [PMID: 2196040] CrossrefMedlineGoogle Scholar
    • 3. Boyko EJLeonetti DLBergstrom RWNewell-Morris LFujimoto WYVisceral adiposity, fasting plasma insulin, and blood pressure in Japanese-Americans. Diabetes Care1995;18:174-81. [PMID: 7729294] CrossrefMedlineGoogle Scholar
    • 4. Hayashi TBoyko EJLeonetti DLMcNeely MJNewell-Morris LKahn SEet al Visceral adiposity and the prevalence of hypertension in Japanese Americans. Circulation2003;108:1718-23. [PMID: 12975250] CrossrefMedlineGoogle Scholar
    • 5. Boyko EJLeonetti DLBergstrom RWNewell-Morris LFujimoto WYVisceral adiposity, fasting plasma insulin, and lipid and lipoprotein levels in Japanese Americans. Int J Obes Relat Metab Disord1996;20:801-8. [PMID: 8880345] MedlineGoogle Scholar
    • 6. Fujimoto WYBergstrom RWBoyko EJChen KWLeonetti DLNewell-Morris Let al Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. Diabetes Care1999;22:1808-12. [PMID: 10546012] CrossrefMedlineGoogle Scholar
    • 7. Boyko EJFujimoto WYLeonetti DLNewell-Morris LVisceral adiposity and risk of type 2 diabetes: a prospective study among Japanese Americans. Diabetes Care2000;23:465-71. [PMID: 10857936] CrossrefMedlineGoogle Scholar
    • 8. Folsom ARPrineas RJKaye SASoler JTBody fat distribution and self-reported prevalence of hypertension, heart attack, and other heart disease in older women. Int J Epidemiol1989;18:361-7. [PMID: 2767849] CrossrefMedlineGoogle Scholar
    • 9. Okosun ISPrewitt TECooper RSAbdominal obesity in the United States: prevalence and attributable risk of hypertension. J Hum Hypertens1999;13:425-30. [PMID: 10449204] CrossrefMedlineGoogle Scholar
    • 10. Cassano PASegal MRVokonas PSWeiss STBody fat distribution, blood pressure, and hypertension. A prospective cohort study of men in the normative aging study. Ann Epidemiol1990;1:33-48. [PMID: 1669488] CrossrefMedlineGoogle Scholar
    • 11. Folsom ARPrineas RJKaye SAMunger RGIncidence of hypertension and stroke in relation to body fat distribution and other risk factors in older women. Stroke1990;21:701-6. [PMID: 2339449] CrossrefMedlineGoogle Scholar
    • 12. Gillum RFMussolino MEMadans JHBody fat distribution and hypertension incidence in women and men. The NHANES I Epidemiologic Follow-up Study. Int J Obes Relat Metab Disord1998;22:127-34. [PMID: 9504320] CrossrefMedlineGoogle Scholar
    • 13. Haffner SMValdez RMorales PAMitchell BDHazuda HPStern MPGreater effect of glycemia on incidence of hypertension in women than in men. Diabetes Care1992;15:1277-84. [PMID: 1425089] CrossrefMedlineGoogle Scholar
    • 14. Haffner SMMiettinen HGaskill SPStern MPMetabolic precursors of hypertension. The San Antonio Heart Study. Arch Intern Med1996;156:1994-2001. [PMID: 8823152] CrossrefMedlineGoogle Scholar
    • 15. Shetterly SMRewers MHamman RFMarshall JAPatterns and predictors of hypertension incidence among Hispanics and non-Hispanic whites: the San Luis Valley Diabetes Study. J Hypertens1994;12:1095-102. [PMID: 7852755] CrossrefMedlineGoogle Scholar
    • 16. Johnson DPrud'homme DDespres JPNadeau ATremblay ABouchard CRelation of abdominal obesity to hyperinsulinemia and high blood pressure in men. Int J Obes Relat Metab Disord1992;16:881-90. [PMID: 1337343] MedlineGoogle Scholar
    • 17. Fujimoto WYLeonetti DLKinyoun JLShuman WPStolov WCWahl PWPrevalence of complications among second-generation Japanese-American men with diabetes, impaired glucose tolerance, or normal glucose tolerance. Diabetes1987;36:730-9. [PMID: 3569672] CrossrefMedlineGoogle Scholar
    • 18. Fujimoto WYBergstrom RWLeonetti DLNewell-Morris LLShuman WPWahl PWMetabolic and adipose risk factors for NIDDM and coronary disease in third-generation Japanese-American men and women with impaired glucose tolerance. Diabetologia1994;37:524-32. [PMID: 8056192] CrossrefMedlineGoogle Scholar
    • 19. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care1997;20:1183-97. [PMID: 9203460] CrossrefMedlineGoogle Scholar
    • 20. Warnick GREnzymatic methods for quantification of lipoprotein lipids. Methods Enzymol1986;129:101-23. [PMID: 3724535] CrossrefMedlineGoogle Scholar
    • 21. Shuman WPMorris LLLeonetti DLWahl PWMoceri VMMoss AAet al Abnormal body fat distribution detected by computed tomography in diabetic men. Invest Radiol1986;21:483-7. [PMID: 3721806] CrossrefMedlineGoogle Scholar
    • 22. Schoen REThaete FLSankey SSWeissfeld JLKuller LHSagittal diameter in comparison with single slice CT as a predictor of total visceral adipose tissue volume. Int J Obes Relat Metab Disord1998;22:338-42. [PMID: 9578239] CrossrefMedlineGoogle Scholar
    • 23. Han TSKelly IEWalsh KGreene RMLean MERelationship between volumes and areas from single transverse scans of intra-abdominal fat measured by magnetic resonance imaging. Int J Obes Relat Metab Disord1997;21:1161-6. [PMID: 9426384] CrossrefMedlineGoogle Scholar
    • 24. McNeely MJShofer JBSchwartz RSLeonetti DLBoyko EJNewell-Morris Let al Use of computed tomography regional fat areas to estimate adiposity: correlation with hydrodensitometry, bioelectrical impedence, skinfold thickness, and body mass index. Obes Res1999;7 Suppl 1 47S. Google Scholar
    • 25. Leonetti DLTsunehara CHWahl PWFujimoto WYEducational attainment and the risk of non–insulin-dependent diabetes or coronary heart disease in Japanese-American men. Ethn Dis1992;2:326-36. [PMID: 1490129] MedlineGoogle Scholar
    • 26. Rothman KJGreenland SMeasures of disease frequency.. In: Rothman KJ, Greenland S, eds. Modern Epidemiology. 2nd ed. Philadelphia: Lippincott–Raven; 1998:29-46. Google Scholar
    • 27. Hosmer DWLemeshow SApplied Logistic Regression. 2nd ed. New York: Wiley; 2000:91-116. Google Scholar
    • 28. Wannamethee SGCamargo CAManson JEWillett WCRimm EBAlcohol drinking patterns and risk of type 2 diabetes mellitus among younger women. Arch Intern Med2003;163:1329-36. [PMID: 12796069] CrossrefMedlineGoogle Scholar
    • 29. Kleinbaum DGLogistic Regression: A Self-Learning Text. 2nd ed. New York: Springer; 1994:191-222. Google Scholar
    • 30. Katz MHMultivariable analysis: a primer for readers of medical research. Ann Intern Med2003;138:644-50. [PMID: 12693887] LinkGoogle Scholar
    • 31. Glantz SASlinker BKPrimer of Applied Regression and Analysis of Variance. New York: McGraw-Hill; 1990:181-238. Google Scholar
    • 32. Kanai HMatsuzawa YKotani KKeno YKobatake TNagai Yet al Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension1990;16:484-90. [PMID: 2228147] CrossrefMedlineGoogle Scholar
    • 33. Landsberg LInsulin-mediated sympathetic stimulation: role in the pathogenesis of obesity-related hypertension (or, how insulin affects blood pressure, and why). J Hypertens2001;19:523-8. [PMID: 11327624] CrossrefMedlineGoogle Scholar
    • 34. Gupta AKClark RVKirchner KAEffects of insulin on renal sodium excretion. Hypertension1992;19:I78-82. [PMID: 1730458] CrossrefMedlineGoogle Scholar
    • 35. Anderson EAHoffman RPBalon TWSinkey CAMark ALHyperinsulinemia produces both sympathetic neural activation and vasodilation in normal humans. J Clin Invest1991;87:2246-52. [PMID: 2040704] CrossrefMedlineGoogle Scholar
    • 36. Cardillo CNambi SSKilcoyne CMChoucair WKKatz AQuon MJet al Insulin stimulates both endothelin and nitric oxide activity in the human forearm. Circulation1999;100:820-5. [PMID: 10458717] CrossrefMedlineGoogle Scholar
    • 37. Wajchenberg BLSubcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev2000;21:697-738. [PMID: 11133069] CrossrefMedlineGoogle Scholar
    • 38. Kazumi TKawaguchi ASakai KHirano TYoshino GYoung men with high-normal blood pressure have lower serum adiponectin, smaller LDL size, and higher elevated heart rate than those with optimal blood pressure. Diabetes Care2002;25:971-6. [PMID: 12032101] CrossrefMedlineGoogle Scholar
    • 39. Poli KATofler GHLarson MGEvans JCSutherland PALipinska Iet al Association of blood pressure with fibrinolytic potential in the Framingham offspring population. Circulation2000;101:264-9. [PMID: 10645922] CrossrefMedlineGoogle Scholar
    • 40. Shimomura IFunahashi TTakahashi MMaeda KKotani KNakamura Tet al Enhanced expression of PAI-1 in visceral fat: possible contributor to vascular disease in obesity. Nat Med1996;2:800-3. [PMID: 8673927] CrossrefMedlineGoogle Scholar
    • 41. Alessi MCPeiretti FMorange PHenry MNalbone GJuhan-Vague IProduction of plasminogen activator inhibitor 1 by human adipose tissue: possible link between visceral fat accumulation and vascular disease. Diabetes1997;46:860-7. [PMID: 9133556] CrossrefMedlineGoogle Scholar
    • 42. Motoshima HWu XSinha MKHardy VERosato ELBarbot DJet al Differential regulation of adiponectin secretion from cultured human omental and subcutaneous adipocytes: effects of insulin and rosiglitazone. J Clin Endocrinol Metab2002;87:5662-7. [PMID: 12466369] CrossrefMedlineGoogle Scholar
    • 43. McNeely MJBoyko EJType 2 diabetes prevalence in Asian Americans: results of a national health survey. Diabetes Care2004;27:66-9. [PMID: 14693968] CrossrefMedlineGoogle Scholar
    • 44. Wang JThornton JCRussell MBurastero SHeymsfield SPierson RNAsians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr1994;60:23-8. [PMID: 8017333] CrossrefMedlineGoogle Scholar