Interaction of General or Central Obesity and Hypertension on Diabetes: Sex-Specific Differences in a Rural Population in Northeast China

Abstract

Purpose Some studies have established an association between hypertension or obesity and the risk of diabetes. This study aimed to examine the interaction of hypertension and obesity on diabetes. Participants and Methods The data of 11,731 Chinese men and women were analyzed from the 2012–2013 Northeast China Rural Cardiovascular Health Study. The interaction was examined by both additive and multiplicative scales. General obesity was measured by body mass index (BMI); central obesity was defined by waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHpR). Results After controlling for potential confounders, the odds ratios for diabetes were 3.864 (3.205–4.660), 4.500 (3.673–5.514), 4.932 (3.888–6.255) and 4.701 (3.817–5.788) for the combinations of hypertension and BMI, WC, WHtR or WHpR, respectively, which had the highest risk of diabetes among the four combinations. Notwithstanding the multiplicative interactions showed statistically significant in all analyses, the results of additive interactions were not consistent, suggesting the diabetes risk from female BMI (relative excess risk due to interaction (RERI): 1.136, 95% CI: 0.127–2.146, attributable proportion due to interaction (AP): 0.267, 95% CI: 0.057–0.477, synergy index (S):1.536, 95% CI: 1.017–2.321) or female WHpR (RERI: 1.076, 95% CI: 0.150–2.002, AP:0.205, 95% CI: 0.037–0.374, S:1.340, 95% CI: 1.012–1.775) was additive to the risk from hypertension. Conclusion The findings suggest that high BMI and high WHpR have synergistic interactions with hypertension on the risk of diabetes for females. The results of this study also suggest that BMI and WHpR, rather than WC, should be used for the diagnosis of metabolic syndrome in Chinese population.

Effect of Hypertension, Waist-to-Height Ratio, and Their Transitions on the Risk of Type 2 Diabetes Mellitus: Analysis from the China Health and Retirement Longitudinal Study

“…We found high prevalence of NHEW and HTEW in females as compared to males, which is more likely to develop T2DM. This result is in line with previous reports in the literature [ 26 , 27 ]. These gender differences may be partly related to sex hormones, such as estrogen.…”

“…These findings were consistent with a previous study conducted in northeast China, which observed the interactive association of hypertension and WHtR with T2DM. The authors of that study found that the risk for T2DM is 3.1-, 2.4-, and 4.9-fold higher in individuals with an elevated WHtR, hypertension, and both conditions, respectively, than in individuals without these conditions [ 26 ].…”

“…However, the combined effect of hypertension and obesity on T2DM has not been widely studied. Although several studies have demonstrated a very strong association between hypertension and obesity in Chinese adults with T2DM [ 26 , 27 ], the effects of the transition patterns of these two conditions on the development of T2DM are rather elusive. Increasing evidence has shown that early intervention of hypertension and obesity can substantially reduce T2DM risk, induce T2DM remission, and even preclude complications [ 28 – 30 ].…”

Interaction effect between overweight/obesity and alcohol consumption on hypertension risk in China: a longitudinal study

“…When interaction among aetiologic factors exists in a target population, adequately accounting for that interaction by researchers allows a more accurate description of the risk factors’ potential to cause harm, and hence the public health measures that are necessary to reduce that harm 42. Interaction can be assessed on both additive and multiplicative scales,43 44 whereas multiplicative interaction may be viewed as relevant to etiologic understanding, additive interaction may be viewed as a public health measure relevant to prioritising resource allocation in efforts at prevention. Consequently, both additive and multiplicative interaction analysis were performed in this study.…”

Body Mass Index Is Independently Associated with the Presence of Ischemia in Myocardial Perfusion Imaging

“…In accordance with our findings, Hammer et al reported a correlation of CAD with BMI and WC in women [ 45 ]. Another study in Chinese females reported that a high BMI in addition to hypertension accelerated the risk for type II diabetes mellitus [ 46 ], an additional risk for cardiovascular events. Similarly, Chen et al studied Chinese people with normal BMIs for their predisposition to develop type II diabetes mellitus depending on their WC.…”