Visceral Adiposity Is an Independent Predictor of Incident Hypertension in Japanese Americans

15 June 2004 | Volume 140 Issue 12 | Pages 992-1000

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.

Editors' Notes Context Central obesity and hypertension are well-established components of the metabolic syndrome, but what exactly is the relationship between visceral adiposity and hypertension? Contribution This prospective study used computed tomography to measure multiple body fat areas of 300 middle-aged, normotensive Japanese Americans. Ninety-two participants developed hypertension within 10 to 11 years. Greater visceral adiposity, independent of other measures of body fat and other risk factors, such as plasma insulin and glucose levels, was associated with increased risk for hypertension. Cautions Relationships between visceral adiposity and the development of hypertension may vary in different ethnic groups. –The Editors

 

Author and Article Information

From Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle, Washington.

Acknowledgment: The authors thank staff members, especially Jane Shofer, for skilled assistance. They also thank the King County Japanese-American Community for support and cooperation.

Grant Support: By National Institutes of Health grants DK-31170, HL-49293, and DK-02654; by facilities and services provided by the Diabetes and Endocrinology Research Center (grant DK-17047), Clinical Nutrition Research Unit (grant DK-35816), and the General Clinical Research Center (grant RR-00037) at the University of Washington; and by the Medical Research Service and Cooperative Studies Program of the Department of Veterans Affairs, Seattle, Washington.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Edward J. Boyko, MD, MPH, Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System (S-152E), 1660 South Columbian Way, Seattle, WA 98108; e-mail, eboyko{at}u.washington.edu.

Current Author Addresses: Drs. Hayashi and Boyko: Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, (S-152E), 1660 South Columbian Way, Seattle, WA 98108.

Drs. Leonetti and Newell-Morris: Department of Anthropology, University of Washington, Box 353100, Seattle, WA 98195-3100.

Dr. McNeely: Division of General Internal Medicine, Department of Medicine, University of Washington, Box 354981, 4311 11th Avenue Northeast, Suite 230, Seattle, WA 98105-4608.

Dr. Kahn: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, Veterans Affairs Puget Sound Health Care System (151) and University of Washington, 1660 South Columbian Way, Seattle, WA 98108.

Dr. Fujimoto: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Box 356426, 1959 Northeast Pacific Street, Seattle, WA 98195-6426.

Author Contributions: Conception and design: T. Hayashi, E.J. Boyko, D.L. Leonetti, M.J. McNeely, L. Newell-Morris, S.E. Kahn, W.Y. Fujimoto.

Analysis and interpretation of the data: T. Hayashi, E.J. Boyko, S.E. Kahn.

Drafting of the article: T. Hayashi, E.J. Boyko, S.E. Kahn.

Critical revision of the article for important intellectual content: T. Hayashi, E.J. Boyko, M.J. McNeely, L. Newell-Morris, S.E. Kahn, W.Y. Fujimoto.

Final approval of the article: T. Hayashi, E.J. Boyko, D.L. Leonetti, M.J. McNeely, L. Newell-Morris, S.E. Kahn, W.Y. Fujimoto.

Provision of study materials or patients: E.J. Boyko, D.L. Leonetti.

Statistical expertise: T. Hayashi, E.J. Boyko.

Obtaining of funding: E.J. Boyko, D.L. Leonetti, L. Newell-Morris, W.Y. Fujimoto.

Administrative, technical, or logistic support: E.J. Boyko, D.L. Leonetti.

Collection and assembly of data: D.L. Leonetti, M.J. McNeely.