| ObjectivesThe purposes of the study are as follows.Firstly,to analyze current status and progress on the relationship between obesity with hypertension and diabetes mellitus(DM),and understand the knowledge structure and frontiers of the study on this relationship,which will provide evidence for the empirical study.Secondly,to study the relationship between body mass index(BMI),waist circumference(WC),lipid accumulation product index(LAP),visceral adiposity index(VAI),body adiposity index(BAI)and DM in Chinese population aged 40 or older and to discuss and calculate the value of different obesity indexes in predicting hypertension and DM and the cut point value.It will contribute to basis for health education and screening of hypertension and DM,and also provide guidance for clinical work.Additionally,the relationship between neck circumference(NC)and hypertension and DM and the predictive value of NC for the two diseases will be analyzed,and to fill the gap of this research field in China.MethodsIn this study,a visual analysis of 11941 valid article about the relationship between obesity,hypertension and DM in the web of science database was conducted,by using the bibliometric method of CiteSpace software.Based on the data of National Health and Family Planning Commission’s screening project"Screening and Intervention Project for Stroke High-Risk Populations"from 2014 to 2015,the relationship between different obesity indexes and hypertension and DM and their predictive values were analyzed.A questionnaire survey,physical examination and laboratory examination on permanent residents aged≥40 years in 31 provinces in the country were conducted in the program(The data of Tibet was not complete,so data of other 30 provinces were included for analysis).A total number of 726451 people was screened,whom of which 180305 received physical examinations with extreme and missing values excluded.In the end,162880people were included as the sample population of this study.In addition,the relationship between NC and hypertension and DM and its predictive value were analyzed,using the comprehensive intervention project of community population with cardiovascular and cerebrovascular risk factors in Shenzhen in 2015.In this project,4238 local residents with aged 40 years or older were selected from Gushu and TaoyuanJu community in Bao’an District of Shenzhen City,as the subjects.After eliminating the extreme value and missing value cases,4000 people were eventually included in the survey.A preliminary analysis of the survey data by descriptive statistical method was made.T-test and chi-square test were used to compare the differences of the basic situation of the subjects between the gender.Linear regression and trend chi-square test were used to compare the distribution of blood pressure(BP),fasting plasma glucose(FPG)and the prevalence of hypertension and DM among different obesity index groups.Due to the nesting nature of the national stroke screening data,there is strong intra-group correlation between the data,and the results suggested statistical significance.Therefore,multilevel model was used to analyze the relationship between obesity and hypertension and DM.There was no intra-group correlation between the data of community comprehensive intervention survey of cardiovascular and cerebrovascular disease risk factors in Shenzhen in 2015.As a result,logistic regression analysis was used to study the relationship between NC and hypertension and DM.At the same time,Receiver Operating Characteristic(ROC)curve was used to study and calculate the predictive values and their optimal tangent values of different obesity indexes on hypertension and DM.These predictive values will be compared when they were used alone or in combination.Results1.The results of bibliometric analysis.In recent years,the number of study on the relationship between obesity and hypertension and DM in China has generally shown an increasing trend,as the centrality of the research in this area is lower than that of the European and American countries.The research hotspots and frontiers mainly focus on the two main flaws:"related diseases and screening"and"pathogenesis and prevention".2.General characteristics of the study population.The first part was included 162880subjects with an average age of 59.24±11.04 years old,of whom 45.53%were males,mean systolic blood pressure(SBP)was 133.28±18.57 mmHg,and diastolic blood pressure(DBP)was 81.77±11.06mmHg and mean FPG was 5.71±1.70 mmol/L.The second part was included 4000 subjects with an average age of 56.01±9.78 years old,of whom 40.13%were males,mean SBP was 126.16±18.48 mmHg,and DBP was 82.08±11.55 mmHg and mean FPG was 5.74±6.43 mmol/L.3.Relationship between different obesity index and hypertension and DM.With the increase of BMI,WC,LAP,VAI and BAI,the SBP,DBP and FPG level and the prevalence of hypertension and DM increases(P<0.001).It’s showed based on the results of multievel models analysis that BMI has the greatest impact on the risk of hypertension in the population as compared with other obesity indicators,and one standard deviation(SD)of BMI would give rise to an increase of 53.9%(95%CI:1.514 to 1.566)risk of hypertension;of men,WC is more associated with hypertension,and one SD of WC would give rise to an increase of 73.3%(95%CI:1.685 to 1.782)risk of hypertension.For women,the relationship between BMI and hypertension is the strongest,and one SD of BMI would give rise to an increase of 51.0%(95%CI:1.479 to 1.543)risk of hypertension.For DM,among the total population,men and women,WC is most associated with the risk of DM,and one SD of WC would give rise to an increase of 37.4%(95%CI:1.346 to 1.401).35.0%(95%CI:1.305 to 1.396)and 37.8%(95%CI:1.344 to 1.412)risk of DM,respectively.In addition,the risk of hypertension and DM increases with the increase of WC,LAP,VAI and BAI for normal and BMI for overweight patients.4.The value of different obesity indexes in predicting hypertension and DM.It’s showed based on the ROC curve that BMI,WC,LAP,VAI,BAI predicted the AUC of hypertension and DM is more than 0.5(P<0.001).In general,BMI+WC is the most valuable predictor of hypertension for both men and women,compared with other obesity indicators with AUC of 0.708 and 0.721,respectively.WC+LAP has the highest predictive value for DM,with AUC of 0.654 and 0.678 respectively.The results of individual predictors of hypertension and DM show that WC has the highest predictive value of hypertension among men compared with other obesity indicators,with AUC of 0.693.Among women,BMI has a higher value in predicting hypertension,with AUC of 0.709.For DM,male and female,the value of WC in predicting DM is superior to other obesity indexes(AUC is 0.636 and 0.663,respectively),and the above differences are statistically significant.In addition,for men with hypertension,the optimal cut-off points for BMI,WC,LAP,VAI,BAI prediction of hypertension are 25.60 kg/m~2,89.00cm,46.00,2.12 and 27.16,respectively.Of women,the best tangential values are 25.00 kg/m~2,84.00cm,42.00,2.31and 30.50,respectively.For men,the best predictive cutoff points of BMI,WC,LAP,VAI,BAI for DM are 25.10 kg/m~2,89.00cm,45.80,2.01 and 27.10 respectively;and as for women,the best predictive cutoff points are 25.00 kg/m~2,85.00cm,43.25,2.29 and 30.53respectively.5.The relationship between NC and hypertension and DM and its predictive value.With the increasing of NC,SBP,DBP and FPG levels and the prevalence of hypertension and DM increase(P<0.05).The Logistic regression shows that for hypertension,among the total population,men and women,one SD of NC would give rise to an increase of 47.8%(95%CI:1.365 to 1.591).29.1%(95%CI:1.157 to 1.441)and 50.3%(95%CI:1.319~1.712)risk of hypertension,respectively.For DM among the total population,men and women,one SD of NC would give rise to an increase of 21.1%(95%CI:1.108 to 1.323).18.0%(95%CI:1.029 to 1.485)and 18.9%(95%CI:1.052 to 1.343)risk of DM,respectively.In addition,the results of ROC curve show that,among men and women,the AUC of NC for predicting hypertension is 0.594 and 0.702 respectively,and the AUC for predicting DM is0.626 and 0.723,respectively.Among men and women,the best cut-off points for predicting hypertension by NC are 38.10 cm and 32.35 cm respectively,and those for predicting DM are 36.60cm and 33.40 cm respectively.Conclusions1.It is indicated that obesity index is an effective tool for predicting hypertension and DM based on the existing European and American research evidences.However,most of the high-quality researches are mainly based on European and American population,and there are few large-scale surveys based on Chinese population.2.There is a positive correlation between BMI,WC,LAP,VAI,BAI and the risk of hypertension and DM.It also shows a gender difference in the relationship between BMI,WC and hypertension.Among the total population and women,BMI has the greatest effect on the risk of hypertension;while in men,WC is more associated with hypertension.WC has the greatest impact on the risk of DM in the general population,for both men and women.3.The ROC curve shows that BMI+WC is the most effective predictor of hypertension in general;and WC+LAP has the highest value in prediction of DM.It is showed that WC has a higher predictive value for hypertension in men,and BMI has a better predictive effect on hypertension in women,according to the result of the predictive value of each obesity index for hypertension and DM alone.WC has a higher predictive value for DM in both men and women.4.There is a positive correlation between NC and the risk of hypertension and DM.The results of Logistic regression and ROC curve all show that NC is an effective index for predicting the risks of hypertension and DM.Highlights1.In this study,large sample data of national cardiovascular disease screening were used to analyze the relationship between different obesity indexes BMI,WC,LAP,VAI,BAI and the relationship between hypertension and DM among people aged 40 years and above in 30 provinces of China for the first time.Moreover,it calculated the index values of the best point of contact to predict hypertension and DM,that is made up for the limitations of existing research,provide effective indicators and scientific basis for prevention and control of hypertension and DM,and provide guidance for clinical work.2.The study has certain advancement in terms of methodology application.It based on the nesting of data,and firstly adopted a multilevel model to analyze the relationship between different obesity indexes and hypertension and DM among people aged 40 years and above nationwide,so as to solve the problem caused by the neglect of data hierarchy in traditional statistical methods and make the research results more scientific and reasonable.In addition,this study adopted literature measurement to visual analysis the research of the relationship between obesity and hypertension and DM,and cleared about the relationship between obesity and hypertension with prevalence study and knowledge structure and frontier,provided a reference basis for the empirical study.3.Based on the comprehensive intervention survey data of community population for cardiovascular and cerebrovascular disease risk factors,it analyzed the relationship between NC and hypertension and DM about the population of aged 40 years and above ShenZhen city for the first time,and its predictive value,it has certain innovative in the research content to make up for the deficiency of the Chinese people in this field.Limitations1.The study based on the national large sample data,and used the multilevel model to analyze the relationship between different obesity measurement indexes and hypertension and DM,the sample with a large size and good representative,so the research results are relatively reliable.However,as the study is a cross-sectional survey,there are limitations in causal inference.Therefore,cohort studies are needed to further confirm the relationship between different obesity measures and hypertension and diabetes and its predictive value.2.It was included 56 ethnic groups in 30 provinces in this study.The sample representation was good,but about 98.5%of the sample population was Han Nationality.The sample size of the other 55 ethnic groups was too small to compare the differences among ethnic groups.Therefore,ethnic differences in the relationship between different obesity measures and hypertension and DM could be considered in future studies.3.The study estimated different obesity measure the validity of the prediction for high blood pressure and DM by sensitivity,specificity and Youden’s index,the validity of the measurement is acceptable,but as people living standard and health are in a dynamic change,so it need to regular monitoring and inspection,also need further support with cohort data,and ensure its accuracy and effectiveness. |
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