Author + information
- Javier Gómez-Ambrosi, PhD∗ (, )
- Victoria Catalán, PhD,
- Amaia Rodríguez, PhD,
- Javier Salvador, MD, PhD and
- Gema Frühbeck, RNutr, MD, PhD
- ↵∗Metabolic Research Laboratory, Clínica Universidad de Navarra - CIBERobn - IDISNA, Irunlarrea 1, 31008 Pamplona, Spain
We read with great interest the paper by Chandra et al. (1), which showed that baseline visceral adiposity, particularly retroperitoneal fat, was strongly associated with incident hypertension in the Dallas Heart Study.
To analyze the influence of adipose tissue distribution on the development of hypertension, visceral adipose tissue, subcutaneous adipose tissue, and liver fat were quantified by magnetic resonance imaging and spectroscopy, lower body fat was measured by dual-energy x-ray absorptiometry, and the incidence of hypertension was observed after 7 years of follow-up. The authors conclude that visceral adiposity, rather than total adiposity, is more important in the association of obesity with incident hypertension.
Although precise and reproducible techniques were used to measure the different fat depots, body mass index (BMI) was used as a measure of total adiposity. The utility of BMI for diagnosing obesity has been shown to be very practical in population studies. However, despite its wide use, BMI is only a surrogate measure of body fat and does not provide an accurate measurement of body composition (2). Although most studies analyzing the influence of obesity on the development of hypertension use BMI as a proxy of adiposity, direct measurement of body fat percentage may provide more interesting information (3). Therefore, we believe that comparison of the influence of every single fat depot with total adiposity on incident hypertension would be more precise if the authors used a more accurate measure of total adiposity.
The authors performed dual-energy x-ray absorptiometry, so they probably have data available regarding actual total adiposity. Alternatively, they could include the sum of the different fat depots measured (visceral adipose tissue, subcutaneous adipose tissue, and lower body fat) as a more realistic approximation of total adiposity than BMI. Although visceral adipose tissue will surely remain the most influential adipose depot on the development of hypertension, a more precise influence of total adiposity may be obtained. This is important because the cardiometabolic risk of many patients may be underestimated when using BMI because it cannot always properly discriminate the risk of chronic disease at the individual level (4).
Data from the study by Chandra et al. (1) reinforce the notion that focusing on body composition, rather than BMI, when screening for obesity and overweight may be helpful to better estimate cardiometabolic risk in clinical practice (5).
- American College of Cardiology Foundation