Visceral Adiposity Is an Independent Predictor of Incident Hypertension in Japanese Americans
- Tomoshige Hayashi, MD, PhD;
- Edward J. Boyko, MD, MPH;
- Donna L. Leonetti, PhD;
- Marguerite J. McNeely, MD, MPH;
- Laura Newell-Morris, PhD;
- Steven E. Kahn, MB, ChB; and
- Wilfred Y. Fujimoto, MD
- From Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle, Washington.
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.
Article and Author Information
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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.
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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.
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Potential Financial Conflicts of Interest: None disclosed.
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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.
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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.
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Drs. Leonetti and Newell-Morris: Department of Anthropology, University of Washington, Box 353100, Seattle, WA 98195-3100.
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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.
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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.
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Dr. Fujimoto: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Box 356426, 1959 Northeast Pacific Street, Seattle, WA 98195-6426.
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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.
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Analysis and interpretation of the data: T. Hayashi, E.J. Boyko, S.E. Kahn.
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Drafting of the article: T. Hayashi, E.J. Boyko, S.E. Kahn.
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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.
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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.
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Provision of study materials or patients: E.J. Boyko, D.L. Leonetti.
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Statistical expertise: T. Hayashi, E.J. Boyko.
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Obtaining of funding: E.J. Boyko, D.L. Leonetti, L. Newell-Morris, W.Y. Fujimoto.
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Administrative, technical, or logistic support: E.J. Boyko, D.L. Leonetti.
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Collection and assembly of data: D.L. Leonetti, M.J. McNeely.
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