深圳市自然人群不同肥胖指标与高血压关系的研究

The association between different obesity indices and hypertension among local residents in Shenzhen

目的分析深圳市自然人群体质量指数(body mass index,BMI)、体脂率(body fat rate,BFR)、腰高比(waist height ratio,WHtR)、内脏脂肪指数(visceral adiposity index,VAI)与高血压的关系,探讨不同肥胖指标对高血压的预测价值。方法本研究调查对象来自于华南区域自然人群慢性病前瞻性队列研究在广东省深圳市招募的6025名18~79岁常住居民。研究对象以是否患有高血压,分为高血压组和非高血压组,BMI参照中国成人判定标准分为体质量过低、体质量正常、超重、肥胖四组,BFR、WHtR、VAI以四分位数截点依次分为Q1、Q2、Q3、Q4四组。采用logistic回归分析BMI、BFR、WHtR、VAI与高血压患病的关系,应用ROC曲线分析BMI、BFR、WHtR、VAI对高血压的预测效力及切点值。结果本研究共调查6025名居民,其中高血压1164例,高血压患病率19.32%。高血压组的BMI(t=20.75,P<0.01)、BFR(t=9.00,P<0.01)、WHtR(t=27.17,P<0.01)、VAI(Z=-12.80,P<0.01)均高于非高血压组,差异有统计学意义。随着BMI、BFR、WHtR、VAI的增加,男女人群高血压患病率均呈上升趋势,差异有统计学意义(男性χ^(2)趋势=128.37、96.67、185.14、30.23,女性χ^(2)趋势=212.26、168.84、370.72、114.77,均P<0.01)。Logistic回归分析显示,超重组和肥胖组高血压患病风险分别是BMI体质量正常组的2.01倍(95%CI:1.71~2.35)和4.88倍(95%CI:3.88~6.14);BFR第二、三、四分位组高血压患病风险分别是参照组的1.81倍(95%CI:1.46~2.25)、2.99倍(95%CI:2.31~3.86)、4.81倍(95%CI:3.65~6.35);WHtR第二、三、四分位组高血压患病风险分别是参照组的1.76倍(95%CI:1.36~2.28)、2.50倍(95%CI:1.94~3.21)、4.94倍(95%CI:3.85~6.33);VAI第二、三、四分位组高血压患病风险分别是参照组的1.26倍(95%CI:1.00~1.58)、1.65倍(95%CI:1.33~2.05)、2.25倍(95%CI:1.83~2.77)。BMI、BFR、WHtR、VAI预测高血压的ROC曲线下面积(AUC)分别为0.69(95%CI:0.68~0.71)、0.58(95%CI:0.56~0.60)、0.74(95%CI:0.72~0.75)、0.62(95%CI:0.60~0.64),切点值分别为24.17kg/m^(2)、34.15%、0.51、1.49。结论BMI、BFR、WHtR、VAI均与高血压患病相关,WHtR预测高血压效力优于BMI、BFR、VAI。

Objective To explore the association between body mass index(BMI),body fat rate(BFR),waist height ratio(WHtR),visceral adiposity index(VAI)and hypertension among local residents in Shenzhen,and to discuss the predictive value of different obesity indices on hypertension.Methods All 6025study subjects aged 18-79years were permanent local residents a South China cohort in the prospective study of chronic diseases in Shenzhen.They were divided into hypertension and non-hypertension groups based on their blood pressure,and were divided into low body weight,normal body weight,overweight and obesity based upon their BMI,and were divided into Q1,Q2,Q3and Q4groups at quartile cut-off point based on their BFR,WHtR and VAI.Logistic regression model was used to analyze the relationship between BMI,BFR,WHtR,VAI and the incidence of hypertension.ROC curve was used to analyze the predictive efficacy and cut point value of BMI,BFR,WHtR and VAI on hypertension.Results Among 6025residents,1164had hypertension with the prevalence of hypertension of 19.32%.BMI(t=20.75,P<0.01),BFR(t=9.00,P<0.01),WHtR(t=27.17,P<0.01)and VAI(Z=-12.80,P<0.01)in hypertension group were all higher than those in non-hypertension group.With the increase of BMI,BFR,WHtR and VAI,the prevalence of hypertension in both men and women showed an increasing trend(in male:χ^(2)trend128.37,96.67,185.14,30.23;in female:χ^(2)trend212.26,168.84,370.72,114.77,P<0.01).Logistic regression showed that the risks of hypertension in the overweight group and the obese group were 2.01(95%CI:1.71-2.35)and4.88(95%CI:3.88-6.14)times higher than that in the normal weight group.The risks of hypertension in the Q2,Q3,Q4BFR groups were 1.81(95%CI:1.46-2.25),2.99(95%CI:2.31-3.86),4.81(95%CI:3.65-6.35)times of the Q1group.The risks of hypertension in the Q2,Q3,Q4WHtR groups were 1.76(95%CI:1.36-2.28),2.50(95%CI:1.94-3.21),4.94(95%CI:3.85-6.33)times higher than in the Q1group.The risks of hypertension in the Q2,Q3,Q4VAI groups were 1.26(95%CI:1.00-1.58),1.65(95%CI:1.33-2.05),2.25(95%CI:1.83-2.77)times higher than that in the Q1group.The area under the ROC curve(AUC)of BMI,BFR,WHtR and VAI in predicting hypertension were 0.69(95%CI:0.68-0.71),0.58(95%CI:0.56-0.60),0.74(95%CI:0.72-0.75)and 0.62(95%CI:0.60-0.64)respectively,and the cut point values were 24.17kg/m^(2),34.15%,0.51and 1.49.Conclusions BMI,BFR,WHtR and VAI are all associated with hypertension,and WHtR is better than BMI,BFR and VAI in predicting hypertension.