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• W2009546540 abstract "Obesity, hypertension and type 2 diabetes are rapidly growing public health problems. Associated with the dramatic rise in incidence of obesity, the prevalence of hypertension and diabetes has escalated in the last decade, even in children [1–5]. The driving forces linking obesity, hypertension and diabetes remain to be clarified, due in part to the fact that genetic, environmental, lifestyle and behaviour confounders are involved in generating the disease state. For instance, ethnic differences related to distribution of genetic confounders in the risk of hypertension in African compared with white adults have been reported by some [6–8], but not others [9–11]. The different prevalence of obesity and body composition among various ethnicities has also been documented, thus the definition for obesity is different between, for instance, white and Asian populations. Therefore, one could speculate that differences in body composition may play an important role in explaining ethnic differences in the prevalence of hypertension. Ethnicity is a confounder for the prevalence and severity of hypertension and obesity, and it may be linked to the distribution of genetic polymorphisms related to obesity and hypertension [10,11]. For example, Gln27Glu, β2-adrenoceptor polymorphism, which has been demonstrated to be associated with obesity and hypertension [12–14], has different distributions between white and Asian populations [12–18]. Recently, it was reported that ethnicity and genetics are more important than diabetes mellitus and hypertension in producing cardiovascular events in a Puerto Rico population [19]. A number of clinical and epidemiological investigations showed the close linkage between body weight and BP levels in cross-sectional clinical and epidemiological studies. Importantly, several longitudinal studies have demonstrated weight gain-induced BP elevations [20], weight loss-induced BP reduction [21–23] and resistance to lose weight or resistance to weight loss-induced BP reduction [24], but those studies were conducted in the different ethnic populations separately. In the current issue of the Journal of Hypertension, Grootveld et al.[25] compare the relationship between body composition (BMI, body weight, fat distribution and waist/hip ratio, and waist and hip circumferences) and the prevalence of the onset of hypertension over a 9-year period in the three different ethnic groups, white (Dutch) (n = 147), South Asian Surinamese (n = 82) and African Surinamese (n = 132), who were normotensive at the entry period, using a longitudinal design over 9 years. The ‘Surinamese in the Netherlands: study on ethnicity and health (SUNSET)’ study was part of the larger ‘Healthy Life in an Urban Setting (HELIUS)’ study, which included 30 000 individuals from six different ethnic groups. The 1444 individuals in the ‘SENSET’ study were mainly first-generation Surinamese migrants who had been living in Amsterdam during the period 2001–2003. The authors found that African Surinamese had the highest and whites had the lowest prevalence of hypertension at the baseline period. Baseline body composition (body weight, fat distribution) and weight gain over 9 years were all positively associated with the risk of development of hypertension in all three ethnic groups; however, there was no statistical evidence for different associations between ethnic groups in weight gain-induced risk of developing hypertension over the 9-year period. Therefore, Grootveld et al.[25] concluded that the ethnic differences in the prevalence of hypertension were only partly explained by body weight, fat distribution or weight change. However, both sexes of South Asian Surinamese, and especially African Surinamese women, had much higher prevalence of weight gain (≥1.0 or ≥2.9 kg/m2) than the Dutch (white) population, but absolute BP elevations over 9 years were similar. The strength of their study was the focus on the ethnic differences (genetic differences) on prevalence of hypertension, with exclusion of possible differing environmental factors (i.e. climate, diet and lifestyle) on obesity and hypertension development. In the study by Grootveld et al.[25], a large part (31%) of the baseline population was excluded due to the presence of hypertension at the entry period. The level of education for whites was highest, with 40–65% of whites (62.7% of men, 40.5% of women) being educated at the university level. On the contrary, only 15–23% of African Surinamese (15.9% of men, 22.2% of women) and South Asian Surinamese (10.8% of men, 14.9% of women) had university education. Current smoking rate was observed to be approximately double in the African Surinamese male population compared with their white counterparts. Physical activity was less in African Surinamese compared with Caucasians. The education level, socioeconomic status, smoking status and physical activity are known as important determinants for the onset and developments of obesity and hypertension [26,27]. The Surinamese, either South Asian or African, especially the first-generation migrants, might have more stress than whites leading to sympathetic nervous activation, which might lead to subsequent weight gain and blood pressure (BP) elevation [28]. In addition, African Surinamese and South Asian Surinamese had significantly higher positive family history of hypertension, by 1.5–2 fold, than the Dutch population. The individuals with a positive family history of hypertension and obesity, as a marker of genetic background for hypertension and obesity, have different mechanisms associated with the onset and maintenance of hypertension [29,30]. Therefore, it is hard to clarify that the different ethnicities directly contribute to high prevalence of hypertension at the entry period, because higher prevalence of a positive family history of hypertension, lower education, higher smoking rate and less physical activity might also relate to the onset of obesity and hypertension either prior to or postenrolment into the study. In addition, the baseline BP levels are an important determinant for BP levels at the 9-year period, although the differences of average BP levels were very small among the three study groups. Another possibility of ethnic differences on prevalence of hypertension might be understanding health. Very recently, a comparative study on cardiovascular risks in the same ethnic group (African-Americans) between different area in the United States (the Virgin Islands and 50 US states) was published [31]. African-Americans from the US Virgin Islands had lower cardiovascular risk and risk factor prevalence than those from 50 US states, but these lower rates were not explained by differences in health behaviours or socio-economic status in this study. This study highlighted the importance of ‘understanding health’, or perhaps different diet and lifestyle on the cause of racial/ethnic variation [5,31,32]. A limitation of the SUNSET study was the limited consistency of socio-economic status, behaviours and the environmental factors such as diet (foods), nutrition and lifestyle between the three different ethnics. The inclusion of the first migrant with their own culture might also bias the results. One of the other possible methods to exclude the influence of environmental factors may, perhaps, be via twin studies. Twin studies have been largely responsible for showing the effects of genetic variance on a quantitative trait [33]. Environmental confounders are minimized because twin children are usually exposed to similar environments. BP was first shown to be heritable in a twin study. Intermediary phenotypes, such as components of the renin–angiotensin system, sympathetic nervous system, renal function and the ability to excrete electrolytes, which are also known to be involved in the pathogenesis of the onset and maintenance of hypertension, are also heritable [29,30,34]. Previously, Harrap's group analysed the effects of environmental factors on BMI and BP phenotype in 767 adults of a general population sample of families enriched with twins (66 pairs of monozygotic twins and 84 pairs of dizygotic twins). They found that the same genes and many of the same family environmental factors determined variation in both SBP and DBP, but SBP and BMI shared genetic and family environmental determinants to a lesser degree. They concluded that for SBP and BMI, the correlations were 30% for genetic and 22% for shared environmental effects [33]. Nan et al.[35] analysed the genetic influences on BMI in preadolescence, young adulthood and late adulthood using 8179 monozygotic and 9977 dizygotic twins from 12 published studies, and 629 monozygotic twins and 594 dizygotic twins from individual participant data of four twin registries in 2012. In this meta-analysis, the structural equation modelling with intrapair twin correlations showed that the heritability of BMI remained high over all age categories ranging from 61 to 80% for male and female individuals combined, although the importance of the environmental determinants for BMI increased from 14 to 40% with increasing age. This study showed that the long-term environmental effects are stronger determinants than the genetic background [35]. This study suggests that comparisons in young populations with different ethnicity would be better to minimize the environmental influence on the relationships between body compositions and hypertension. Therefore, one could hypothesize that to clarify the genetic and ethnic differences in body weight–BP level inter-relationships, studies should be conducted in adolescents or young individuals with monozygotic twins of differing ethnicity grown up in the same area. Grootveld et al.[25] will have a large body of longitudinal data in the ‘HELIUS’ study, thus they may be able to clarify which factor [body compositions, genetic, environmental, lifestyle including diet, socioeconomic, understanding health (health education)] is most important in the prevalence of hypertension. A better understanding is very important to prevent or delay the onset of hypertension and obesity in these ethnic groups. ACKNOWLEDGEMENTS Conflicts of interest The author declares no conflict of interest." @default.
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• W2009546540 title "Do ethnic differences contribute to the relationship between body composition and hypertension?" @default.
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