Korean J Health Promot.  2023 Sep;23(3):130-138. 10.15384/kjhp.2023.23.3.130.

Effects of Obesity Type on Diabetes and Hypertension in Obese Korean Adults

• Kim JH
• Oh HS

• KMID: 2546775
• DOI: http://doi.org/10.15384/kjhp.2023.23.3.130

Abstract

Background
Obesity is a major cause of diabetes and hypertension. Previous studies have analyzed the effects of obesity on diabetes and hypertension by comparing non-obese and obese groups. Here, we investigated the effects of obesity type through comparison between obesity types in obese adults.
Methods
The sample comprised 8,914 adults, classified as obese according to body mass index criteria or waist circumference criteria, selected from the Korean National Health and Nutrition Examination Survey (2016-2020). Obesity was classified as abdominal obesity-only, general obesity-only, and abdominal and general obesity. The effects of obesity type on diabetes and hypertension were analyzed using logistic regression model.
Results
12.78% of participants exhibited abdominal obesity-only, 22.35% had general obesity-only, and 64.78% had both types. The proportion of patients aged ≥60 years was 57.52% in the abdominal obesity-only group, while 17.12% in the general obesity-only group. The general obesity-only group had a lower incidence of diabetes than the abdominal obesity-only group (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.47-0.77), and the abdominal and general obesity group had a higher incidence of hypertension than the abdominal obesity-only group (OR, 1.82; 95% CI, 1.54-2.15).
Conclusions
Abdominal obesity has a stronger association with diabetes than general obesity, and the risk of hypertension is greatest when both obesity types coexist. Individuals with abdominal obesity-only are likely to be excluded from obesity management, especially when aged ≥60 years. The risk of hypertension is much greater when abdominal and general obesity coexist, emphasizing the need to use both body mass index and waist circumference to define obesity.

Keyword

Abdominal obesity; General obesity; Diabetes; Hypertension

Figure

• 

  Fig. 1. Types of obesity and rates of diabetes and hypertension by age group. OB_WC, obesity-only waist circumference; OB_BMI, obesity-only body mass index. aP-values were obtained by chi-square tests of complex survey data.

Reference

1. Lee MN, Choi YS, Kim SD. The leading factors of obesity and severe obesity in Korean adults during the COVID-19 pandemic. Int J Environ Res Public Health. 2022; 19(19):12214.

2. Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019; 92:6–10.

3. Hall ME, do Carmo JM, da Silva AA, Juncos LA, Wang Z, Hall JE. Obesity, hypertension, and chronic kidney disease. Int J Nephrol Renovasc Dis. 2014; 7:75–88.

4. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol. 2018; 34(5):575–84.

5. Patel SA, Ali MK, Alam D, Yan LL, Levitt NS, Bernabe-Ortiz A, et al. Obesity and its relation with diabetes and hypertension: a cross-sectional study across 4 geographical regions. Glob Heart. 2016; 11(1):71–9.e4.

6. Bailey KV, Ferro-Luzzi A. Use of body mass index of adults in assessing individual and community nutritional status. Bull World Health Organ. 1995; 73(5):673–80.

7. Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review. Nutr Today. 2015; 50(3):117–28.

8. Gujral UP, Weber MB, Staimez LR, Narayan KMV. Diabetes among non-overweight individuals: an emerging public health challenge. Curr Diab Rep. 2018; 18(8):60.

9. Zoccali C, Torino C, Tripepi G, Mallamaci F. Assessment of obesity in chronic kidney disease: what is the best measure? Curr Opin Nephrol Hypertens. 2012; 21(6):641–6.

10. Ross R, Neeland IJ, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity. Nat Rev Endocrinol. 2020; 16(3):177–89.

11. Sun JY, Huang WJ, Hua Y, Qu Q, Cheng C, Liu HL, et al. Trends in general and abdominal obesity in US adults: evidence from the National Health and Nutrition Examination Survey (2001-2018). Front Public Health. 2022; 10:925293.

12. Nam GE, Kim YH, Han K, Jung JH, Rhee EJ, Lee SS, et al. Obesity fact sheet in Korea, 2019: prevalence of obesity and abdominal obesity from 2009 to 2018 and social factors. J Obes Metab Syndr. 2020; 29(2):124–32.

13. Yamada T, Kimura-Koyanagi M, Sakaguchi K, Ogawa W, Tamori Y. Obesity and risk for its comorbidities diabetes, hypertension, and dyslipidemia in Japanese individuals aged 65 years. Sci Rep. 2023; 13(1):2346.

14. Ren H, Guo Y, Wang D, Kang X, Yuan G. Association of normal-weight central obesity with hypertension: a cross-sectional study from the China health and nutrition survey. BMC Cardiovasc Disord. 2023; 23(1):120.

15. Choi D, Choi S, Son JS, Oh SW, Park SM. Impact of discrepancies in general and abdominal obesity on major adverse cardiac events. J Am Heart Assoc. 2019; 8(18):e013471.

16. Sangrós FJ, Torrecilla J, Giráldez-García C, Carrillo L, Mancera J, Mur T, et al. Association of general and abdominal obesity with hypertension, dyslipidemia and prediabetes in the PREDAPS study. Rev Esp Cardiol (Engl Ed). 2018; 71(3):170–7.

17. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157–63.

18. Oh HS. Important significant factors of health-related quality of life (EQ-5D) by age group in Korea based on KNHANES (2014). JKDISS. 2017; 28(3):573–84.

19. Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010; 55(4):622–7.

20. Hu L, Huang X, You C, Li J, Hong K, Li P, et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PLoS One. 2017; 12(9):e0183934.

21. Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006; 444(7121):840–6.

22. Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr Metab Cardiovasc Dis. 2007; 17(4):319–26.

23. Westphal SA. Obesity, abdominal obesity, and insulin resistance. Clin Cornerstone. 2008; 9(1):23–9.

24. Pouliot MC, Després JP, Nadeau A, Moorjani S, Prud'Homme D, Lupien PJ, et al. Visceral obesity in men. Associations with glucose tolerance, plasma insulin, and lipoprotein levels. Diabetes. 1992; 41(7):826–34.

25. Lee JJ, Beretvas SN, Freeland-Graves JH. Abdominal adiposity distribution in diabetic/prediabetic and nondiabetic populations: a meta-analysis. J Obes. 2014; 2014:697264.

26. Phillips LK, Prins JB. The link between abdominal obesity and the metabolic syndrome. Curr Sci. 2008; 10(2):156–64.

27. Bosy-Westphal A, Geisler C, Onur S, Korth O, Selberg O, Schrezenmeir J, et al. Value of body fat mass vs anthropometric obesity indices in the assessment of metabolic risk factors. Int J Obes (Lond). 2006; 30(3):475–83.

28. Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. J Intern Med. 2003; 254(6):555–63.

29. Rhee EJ, Cho JH, Kwon H, Park SE, Jung JH, Han KD, et al. Association between abdominal obesity and increased risk for the development of hypertension regardless of physical activity: a nationwide population-based study. J Clin Hypertens (Greenwich). 2018; 20(10):1417–26.

30. Ostchega Y, Hughes JP, Terry A, Fakhouri TH, Miller I. Abdominal obesity, body mass index, and hypertension in US adults: NHANES 2007-2010. Am J Hypertens. 2012; 25(12):1271–8.