The Role of Body Fat and Fat Distribution in Hypertension Risk in Urban Black South African Women

Abstract

Developing countries are disproportionately affected by hypertension, with Black women being at greater risk, possibly due to differences in body fat distribution. The objectives of this study were: (1) To examine how different measures of body composition are associated with blood pressure (BP) and incident hypertension; (2) to determine the association between baseline or change in body composition, and hypertension; and (3) to determine which body composition measure best predicts hypertension in Black South African women. The sample comprised 478 non-hypertensive women, aged 29–53 years. Body fat and BP were assessed at baseline and 8.3 years later. Body composition was assessed using dual-energy X-ray absorptiometry (DXA) (n = 273) and anthropometry. Hypertension was diagnosed based on a systolic/diastolic BP ≥140/90 mmHg, or medication use at follow-up. All body composition measures increased (p<0.0001) between baseline and follow-up. SBP and DBP increased by ≥20%, resulting in a 57.1% cumulative incidence of hypertension. Both DXA- and anthropometric-derived measures of body composition were significantly associated with BP, explaining 3–5% of the variance. Baseline BP was the most important predictor of hypertension (adjusted OR: 98–123%). Measures of central adiposity were associated with greater odds (50–65%) of hypertension than total adiposity (44–45%). Only change in anthropometric-derived central fat mass predicted hypertension (adjusted OR: 32–40%). This study highlights that body composition is not a major determinant of hypertension in the sample of black African women. DXA measures of body composition do not add to hypertension prediction beyond anthropometry, which is especially relevant for African populations globally, taking into account the severely resource limited setting found in these communities.

Body fat percentage, obesity, and their relation to the incidental risk of hypertension

“…The Aerobics Center Longitudinal Study indicated that men with upper level of BF% had the higher adjusted HRs for hypertension (1.37 [1.11‐1.69]) than men with low level of BF%. In a study for 478 non‐hypertensive South Africans, the risk of hypertension was more significantly associated with baseline body fat mass, trunk, and arm fat mass, rather than changes in these variables . Our study may provide additional insight to the association between BF% and hypertension.…”

“…In a study for 478 non-hypertensive South Africans, the risk of hypertension was more significantly associated with baseline body fat mass, trunk, and arm fat mass, rather than changes in these variables. 21 Our study may provide additional insight to the association between BF% and hypertension.…”

Body mass index, abdominal adiposity, weight gain and risk of developing hypertension: a systematic review and dose–response meta‐analysis of more than 2.3 million participants

“…S1. We identified 56 prospective cohort studies , whose characteristics are presented in Table S2. One study reported results for two separate cohort studies and was regarded as two different studies .…”

“…Finally, 57 prospective cohort studies with 2,343,466 participants and 216,182 incident cases of HTN were included in meta‐analysis. Twenty studies were from the USA , 13 studies were from Europe , 20 studies were from Asia , 2 studies were from Africa , 1 study was from Mexico and 1 was from Brazil . Baseline characteristics of included studies are presented in Table S2, and reported risk estimates in relation to different categories of anthropometric measures in each study are presented in Table S3.…”

Prognostic value of adiposity indices for hypertension

“…Park et al 3 used a tetrapolar bioelectrical impedance analysis. Although most investigators report bioelectrical impedance analyses to estimate BF%, 5,17,19,20,23 other authors determined BF% by means of other methods such as a chemical four-compartment model 16 or the skinfold thickness measurement. 11 The study by Park et al 3 validates previously reported information on the importance of measuring BF% even in non-obese individuals to detect those who have an increased risk of developing hypertension, in a Korean population.…”