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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 19  |  Issue : 1  |  Page : 34-37

Body fat composition as a marker for risk assessment in hypertension


1 Armed Forces Medical Services, Ministry of Defence, Vishakapatnam, Andhra Pradesh, India
2 Station Health Organisation, Vishakapatnam, Andhra Pradesh, India

Date of Web Publication17-Aug-2017

Correspondence Address:
Surg Cdr S Vijay Bhaskar
Jt Dir AFMS (Health), DG-3A, M-Block, Church Road, New Delhi - 110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_11_17

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  Abstract 


Introduction: High blood pressure (BP) is one of the most common chronic medical problems prompting visits to primary health-care providers. The incidence of lifestyle diseases over the years has shown an upward trend in developing countries too, which is a cause of grave concern for the health care professionals. Research suggests that undesirable body composition has a major bearing on health, fitness and lifestyle diseases such as hypertension, ischemic heart disease, and diabetes. Study: The aim of the study was to compare the body composition of hypertensive patients with normal subjects using state of the art impedance based noninvasive body composition analyzer. The study evaluated the body composition of hypertensive patients and compared the same with subjects with normal BP. The study was carried out at a tertiary care hospital in Pune. Body composition variables considered for the study were anthropometry, percent body fat, lean body mass, fat distribution, and visceral fat composition. Results: The analysis of body fat included obesity degree, visceral fat area (VFA), body fat mass, and percent body fat. The mean body fat mass was found to be 21.7Kg. The mean percent Body Fat was 28.9%, which was much higher than the normal. Various parameters depicting body fat were compared. All of them, namely body fat mass, percent body fat, obesity degree, and VFA were found to be significantly higher in hypertensives as compared to the other group. Conclusion: Besides other anthropometric parameters, assessment of VFA may be included as an essential measure to assess and even predict hypertension. Those with high VFA must be monitored closely for developing hypertension and other lifestyle diseases.

Keywords: Body fat composition, hypertension, lifestyle diseases, risk


How to cite this article:
Bhaskar S V, Gupta RK, Kumar MK. Body fat composition as a marker for risk assessment in hypertension. J Mar Med Soc 2017;19:34-7

How to cite this URL:
Bhaskar S V, Gupta RK, Kumar MK. Body fat composition as a marker for risk assessment in hypertension. J Mar Med Soc [serial online] 2017 [cited 2020 Jul 12];19:34-7. Available from: http://www.marinemedicalsociety.in/text.asp?2017/19/1/34/213092




  Introduction Top


High blood pressure (BP) is one of the most common chronic medical problems prompting visits to primary health-care providers.[1],[2] Efforts on prevention of hypertension are largely based on prevention and early detection of risk factors. Essential hypertension, as the term indicates does not have a definite etiology. In the absence this “risk factors” assume great importance. Well-known risk factors fall into the two categories of “nonmodifiable” (age, sex, genetics, etc.) and “modifiable” (diet, alcohol, smoking, physical activity, etc.). Unfortunately, there are numerous risk factors, and it may not always be easy and practical to target all of them with the same intensity. Consequently, most important risk factors are to be targeted on priority.

Research suggests that undesirable body composition has a major bearing on health, fitness, and also lifestyle diseases such as hypertension, ischemic heart disease (IHD), and diabetes. Body composition is traditionally assessed through measurements of body weight, body mass index (BMI), waist-hip circumferences and ratios. These at best are merely indicative of particular parameter(s), which are hypothesized to be indicative of predicting a lifestyle disease like hypertension or IHD. Various studies have suggested that out of various body composition parameters, it is the visceral fat area (VFA) that could be best associated with risk of a chronic condition like hypertension.[3]

The present study endeavored to compare the body composition (including VFA, besides other parameters) of hypertensive patients with normal subjects using state of the art impedance based noninvasive body composition analyzer. The study further tried to find if there was any correlation between various body composition parameters and hypertension. If that be so, it is presumed that a minor positive change in the body composition could bring about a major reduction in the incidence of lifestyle diseases. Thus, the present study assumes great importance.


  Materials and Methods Top


A descriptive observational study was conducted with an aim to examine the body composition of hypertensive and nonhypertensive individuals using state of the art impedance based noninvasive body composition analyzer. The study evaluated the body composition of hypertensive patients and compared the same with subjects with normal BP. The study was carried out at a tertiary care hospital in Pune.

The total sample size, calculated using appropriate statistical methods based on estimated proportions and prevalence rate at a confidence interval of 95% was 200. A total of 101 hypertensive and 104 nonhypertensive individuals participated in the study. Categories of subjects excluded were athletes, those suffering from carcinoma, chronic infections such as tuberculosis, HIV, and AIDS, individuals on nutritional supplements (vitamins, minerals) and any individual with any other ailments.

A questionnaire was developed to record data on personal particulars, history of present illness, relevant medical history, treatment, and family history. Body composition parameters (percent body fat, lean body mass, fat distribution, visceral fat composition) were recorded on the instrument developed. Impedance based body composition analysis recorder (InBody 720, Biospace) was used for body composition measurements. Body composition variables were considered for the study were anthropometry, percent body fat, lean body mass, fat distribution, and visceral fat composition. Certain body composition physiological and biochemical variables were considered which included BP, lipid profile, and blood sugar.

An informed consent was taken from all participants. The study was cleared by the Ethical Committee of the institution.


  Results Top


Body composition of the hypertensive subjects was studied by both anthropometric and body mass analyzer. The mean systolic and diastolic BP in the hypertensive group was 150.24 and 93.67, respectively. The mean BMI among cases was 26.5 and falling in overweight category. The waist-hip ratio (WHR) too was found to be on higher side at 0.94. The analysis of body fat included the degree of obesity, VFA, body fat mass and percent body fat. The mean obesity degree was found to be 120.3, which was higher than normal. The mean VFA was found to be 131.0 cm2 among the hypertensive patients. The mean percent body fat was also calculated, and the same in cases was estimated to be 28.9%, which is much higher than the normal.

On comparison of basic anthropometric parameters, no significant difference was found in the mean height or weight in both groups. BMI was significantly higher in the hypertensive individuals at 26.5 kg/m2 as compared to 24.3 kg/m2 in nonhypertensives (P< 0.001). Similarly, the waist circumference and the WHR were also significantly higher in the hypertensive group (P< 0.001) [Table 1]. Body fat mass, percent body fat, obesity degree, and VFA were also significantly higher in the hypertensive group (P< 0.001). It was also found that the odds ratio for higher VFA between the two groups was 3.04.
Table 1: Comparison of parameters between hypertensive and nonhypertensive groups

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Skeletal muscle mass, bone mineral content, protein, and mineral mass were found to be significantly lower in hypertensive individuals as compared to the nonhypertensives. Similarly, intra- and extra-cellular water mass were also found to be significantly lower in the hypertensive individuals as compared to the non hypertensive group. Biochemical examination of few selected variables was undertaken for the study group. All the biochemical parameters studied were significantly higher in the hypertensive group, except for high-density lipoprotein cholesterol, which was significantly higher in nonhypertensive (P< 0.01) [Table 2].
Table 2: Comparison of biochemical parameters

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The study also intended to examine if there was any correlation between the various parameters with systolic and diastolic BP. The Pearson's correlation coefficient was calculated and the P value for each was analyzed for statistical significance. Waist, hip, and arm muscle circumferences showed statistically significant positive correlation with systolic BP. VFA also showed a fair positive correlation with systolic BP, which was statistically significant (P< 0.05) [Table 3].
Table 3: Correlation analysis between various parameters and high blood pressure

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  Discussion Top


Undesirable body composition has a major bearing on health and fitness. Various other studies have shown a correlation between WHR and significantly higher values of systolic BP.[4] Literature suggests that BMI is positively associated with mean BP and also with the prevalence of hypertension. Whether there is a linear relationship across the entire BMI range remains an unresolved question.[5],[6] In the present study, the association between BMI and BP has been consistently observed.

Body fat distribution has been implicated as a risk factor for various metabolic disorders. Studies have shown that abdominal fat has a significant association with risk of cardiovascular diseases (CVDs).[7],[8] While body composition is traditionally assessed through BMI, waist-hip circumferences, etc., recent research suggests that high VFA could be best associated with risk of hypertension. In the present study, body fat parameters such as body fat mass, percent body fat, obesity degree, and VFA was significantly higher in the cases as compared to controls. In the present study, the VFA was significantly higher in hypertensive patients as compared to the other group. It also showed a fair positive and statistically significant correlation with systolic BP. This may indicate that subjects with high VFA are more liable to end up with hypertension, irrespective of their body weight, waist circumference, or WHR. It is known that a moderate weight loss in initially abdominally obese patients would lead to a preferential mobilization of visceral adipose tissue, which in turn leads to substantial improvements in the metabolic risk profile predictive of a reduced risk of hypertension and coronary heart disease. The exact mechanism by which the visceral fat causes this increased metabolic derangement resulting in increased incidence of lifestyle disease is not clear and is being researched exhaustively.


  Conclusion Top


Besides other anthropometric parameters, assessment of VFA may also be included as an essential measure to assess and even predict hypertension. Those with high VFA must be monitored closely for developing hypertension (and other CVD). Instituting appropriate preventive measures in people with higher VFA and body fat assumes importance.[9] There is a requirement to conduct more body composition studies to define equivalent (equivalent body composition/equivalent disease risk) values across different ethnic groups and define ethnic-specific cutoff points.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Laurenzi M, Mancini M, Menotti A, Stamler J, Stamler R, Trevisan M, et al. Multiple risk factors in hypertension: Results from the Gubbio study. J Hypertens Suppl 1990;8:S7-12.  Back to cited text no. 1
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Skarfors ET, Lithell HO, Selinus I. Risk factors for the development of hypertension: A 10-year longitudinal study in middle-aged men. J Hypertens 1991;9:217-23.  Back to cited text no. 2
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3.
Rosito GA, Massaro JM, Hoffmann U, Ruberg FL, Mahabadi AA, Vasan RS, et al. Pericardial fat, visceral abdominal fat, cardiovascular disease risk factors, and vascular calcification in a community-based sample: The Framingham Heart Study. Circulation 2008;117:605-13.  Back to cited text no. 3
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Lafortuna CL, Agosti F, Proietti M, Adorni F, Sartorio A. The combined effect of adiposity, fat distribution and age on cardiovascular risk factors and motor disability in a cohort of obese women (aged 18-83). J Endocrinol Invest 2006;29:905-12.  Back to cited text no. 4
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Jiang J, Kitano T, Shono M, Wakamiya J, Futatsuka M. Serial study on the association between body mass index and hypertension in rural Japanese. Environ Health Prev Med 2003;8:90-4.  Back to cited text no. 5
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6.
Kaufman JS, Asuzu MC, Mufunda J, Forrester T, Wilks R, Luke A, et al. Relationship between blood pressure and body mass index in lean populations. Hypertension 1997;30:1511-6.  Back to cited text no. 6
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Feldstein CA, Akopian M, Olivieri AO, Kramer AP, Nasi M, Garrido D. A comparison of body mass index and waist-to-hip ratio as indicators of hypertension risk in an urban Argentine population: A hospital-based study. Nutr Metab Cardiovasc Dis 2005;15:310-5.  Back to cited text no. 7
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Fomon SJ, Haschke F, Ziegler EE, Nelson SE. Body composition of reference children from birth to age 10 years. Am J Clin Nutr 1982;35 5 Suppl:1169-75.  Back to cited text no. 8
    
9.
Santos Silva DA, Petroski EL, Peres MA. Is high body fat estimated by body mass index and waist circumference a predictor of hypertension in adults? A population-based study. Nutr J 2012;11:112.  Back to cited text no. 9
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    Tables

  [Table 1], [Table 2], [Table 3]


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[Pubmed] | [DOI]



 

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