A Study Of Interactive Effect Of Different Types Of Obesity On Blood Pressure Using Quantile Regression

Objective:To understand the distribution level of blood pressure,prevalence of hypertension,different types of obesity and prevalence of rural residents in Wushan County,Tianshui City,Gansu Province.The quantile regression analysis was used to estimate the interaction and influence degree of different types of obesity on blood pressure levels,so as to provide the basis for the development of targeted intervention strategies in this region.Methods:The blood pressure and anthropometric obesity indexes of 4809 rural residents aged 35～74 years in the survey area were collected by cross-sectional survey and physical examination.Then,descriptive epidemiological methods were used to analyze the distribution characteristics of blood pressure and obesity of the respondents,and quantile regression model was used to explore the interaction and influence degree of different types of obesity on blood pressure.Results:1.The ASBP and ADBP of the respondents,male and female were132.51±18.70/80.70±11.19mm Hg,132.17±18.85/81.85±11.26mm Hg and 132.74±19.36/79.92±11.08mm Hg,respectively.There was not any gender difference in ASBP（P>0.05）,but the ADBP of male residents was higher than the females（P<0.001）.ASBP showed a trend of increasing with age（P<0.001）.The prevalence of hypertension in the respondents,males and females was 34.52%,34.40%and 40.79%,respectively,and there was no gender difference in the prevalence of hypertension（P>0.05）.Among the 5 obesity indexes,the average WC and VFL of males exceeded those of females,while BMI,PBF and WHt R were lower than those of females.The average PBF declined with age,but the average WHt R and VFL increased with age(P_trend<0.001).The rates of overweight and obesity were 28.63%and6.28%,respectively.The obesity rates of PBF,WC,WHt R and VFL were 29.26%,24.83%,50.32%and 34.00%,respectively.There were not any gender differences in the rates of overweight and obesity（P>0.05）.The obesity rates of PBF,WC and WHt R for women compared with those in men,but the obesity rate of VFL for women was lower than that in men（P<0.001）.2.Quantile regression showed that:BMI overweight and obesity,PBF,WC and WHTR were significantly correlated with the increase of SBP at any sublocus（P<0.05）,and the effectβwas the largest at SBP P₇₅（9.78,14.64,4.44,9.13 and 8.45,respectively）for all types of obesity.There was no significant correlation between VFL obesity and SBP（P>0.05）.On the whole,with the increase of SBP quantile,the effects of all kinds of obesity on SBP were firstly increased and then decreased.Similarly,studies of DBP and blood pressure show that:All the five types of obesity were significantly correlated with DBP elevation at any sub-locus（P<0.05）.Except for PBF obesity,the DBP at P90sub-locus had the largest effect of 3.05.BMI overweight and obesity,WC,WHt R and VFL obesity all had the largest effect ofβat DBP P₇₅.Were 6.13,7.25,5.63,4.72 and2.54,respectively.On the whole,with the increase of DBP quantile,the effects of BMI and PBF obesity on DBP increased,while the effects of BMI overweight,WC,WHTR and VFL obesity on DBP increased first and then decreased.In terms of different genders,except PBF obesity,other types of obesity were significantly correlated with the increase of SBP and DBP at any quantiles in male population（P<0.05）.All the 5types of obesity were significantly correlated with the increase of SBP and DBP in any quantiles of female population（P<0.05）,but VFL obesity had a negative effect on SBP in any quantiles of female population.The effect of all types of obesity on SBP was higher than that of DBP.3.The main effects of different types of obesity on SBP and DBP showed that compared with normal/emasure,the effects of BMI obesity on SBP and DBP were the largest in any subtile any quantiles（β（P10～P90）:9.40-14.64 and 6.58-7.25）.WC obesity significantly affected SBP and DBP before P₅₀(β(P₁₀-P₂₅):8.91-9.71 and 4.73-4.91).BMI overweight had a significant effect on P50 and later SBP and DBPβ(P₅₀～P₉₀):8.91～9.71 and 4.28～6.13.Compared with the two central obesity indexes,the effect of WC obesity on SBP was greater than that of WHTR obesity.However,for DBP,except for DBP P90,the effect of WC obesity on SBP was greater than that of WHTR obesity.The effect of PBF obesity on SBP was the least(β:P₁₀～P₉₀:2.96～4.44),while the effect of VFL obesity on DBP was the least(β:P₁₀～P₉₀:1.12～2.54).4.The interaction between BMI and WC obesity on SBP and DBP showed that all the other interaction terms were significantly correlated with the increase of SBP（P<0.05）,except that"BMI obese＆overweight WC normal"had no significant correlation with P10 and P25 of SBP（P>0.05）.The interaction sizes of different quantiles showed that"BMI obesity＆WC obesity"had a greater interaction on SBP overweight P₅₀ before,and"BMI normal＆WC obesity"had a greater interaction on SBP overweight P₅₀ and after.With the increase of SBP quantile,the effects of"BMI overweight＆WC normal"and"BMI overweight＆WC obese"on SBP increased first and then decreased,while the effects of"BMI normal/emactered＆WC obese"and"BMI obesity＆WC obesity"on SBP decreased first and then increased and then decreased.Similarly,except that"BMI obese＆overweight WC normal"had no significant correlation with P₁₀,P₂₅ and P₅₀ of DBP（P>0.05）,all other interaction terms were significantly correlated with DBP increase（P<0.05）.Comparison of interaction sizes among different quantiles showed that"BMI obesity＆WC obesity"had a greater interaction on SBP P₉₀ quantiles,while"BMI normal＆WC obesity"had a greater influence on DBP at all other quantiles.With the increase of DBP quantile,the influence of"BMI overweight＆WC normal"overweight on DBP increased,"overweight normal BMI/skinny＆WC obesity"and"overweight BMI overweight＆WC obesity"on DBP overweight first decreased,then increased and then decreased,while the fluctuation range of"overweight BMI overweight＆WC obesity"was small（7.57～8.50）.5.The interaction effects of BMI and WHt R on SBP and DBP were similar.Except that"BMI obesity and WHt R were normal",there was no significant correlation between SBP and DBP P₁₀～P₉₀（P>0.05）,the other interaction terms were significantly correlated with the increase of SBP and DBP at any of the quantiles（P<0.05）.The interaction sizes of SBP and DBP at different quantiles were compared.The interaction sizes of SBP and DBP at different quantiles were compared.The interaction sizes of SBP and DBP at P₉₀ quantiles were compared with that of"BMI obesity＆WC obesity".With the increase of SBP quantile,the effects of"BMI overweight＆WHt R normal"and"BMI overweight＆WHt R obese"on SBP decreased first,then increased and then decreased.The effect of"normal BMI/skinny＆WHt R obesity"and"BMI obesity＆WHt R obesity"on SBP increased firstly and then decreased.Similarly,with the increase of DBP quantile,the effect of"BMI overweight＆WHt R normal"on DBP increased overall,while the effect of"BMI normal/skinny＆WHt R obese"and"BMI overweight＆WHt R obese"on DBP first decreased,then increased and then decreased.BMI obesity and WHt R obesity had little effect on DBP（7.45～8.87）.Conclusions:1.BMI,WC and WHt R were all associated with increased blood pressure,and BMI had the greatest effect on blood pressure at any sub-locus.BMI overweight had a greater effect on blood pressure in high scores,while WC obesity had a greater effect on blood pressure in low scores.Overall,the effect of WHt R obesity on blood pressure was smaller than that of WC obesity.VFL obesity in men and PBF obesity in women were associated with increased blood pressure,respectively.2.The interaction between systemic obesity and central obesity on blood pressure in different quantile was different.The superposition of the two kinds of obesity had a greater effect on blood pressure in low quantile,but simple central obesity had a greater effect on blood pressure in high quantile.The effect of central obesity on blood pressure was greatly affected by the level of blood pressure.3.Compared with the interaction between the two types of central obesity and systemic obesity on blood pressure,the superposition effect of WC obesity and systemic obesity on most quantiles SBP was greater than that of WHt R obesity and systemic obesity.For DBP,the superposition effect of WC obesity and systemic obesity on low interstitial DBP was greater than the superposition effect of WHt R obesity and BMI obesity,while the superposition effect of WHt R obesity and systemic obesity on high interstitial DBP was greater than that of WC obesity and systemic obesity.