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. 2023 Oct 2;23(1):1897.
doi: 10.1186/s12889-023-16815-0.

Mediating effect of body fat percentage in the association between ambient particulate matter exposure and hypertension: a subset analysis of China hypertension survey

Yan Xue #  1   2   3 , Jin Li #  1   2   3 , Yu-Nan Xu  4 , Jia-Sheng Cui  1   2   3 , Yue Li  1   2   3 , Yao-Qiong Lu  1   2   3 , Xiao-Zhi Luo  1   2   3 , De-Zhao Liu  1   2   3 , Feng Huang  5   6   7 , Zhi-Yu Zeng  8   9   10 , Rong-Jie Huang  11   12   13
Affiliations

Mediating effect of body fat percentage in the association between ambient particulate matter exposure and hypertension: a subset analysis of China hypertension survey

Yan Xue et al. BMC Public Health. .

Abstract

Background: Hypertension caused by air pollution exposure is a growing concern in China. The association between air pollutant exposure and hypertension has been found to be potentiated by obesity, however, little is known about the processes mediating this association. This study investigated the association between fine particulate matter (aerodynamic equivalent diameter ≤ 2.5 microns, PM2.5) exposure and the prevalence of hypertension in a representative population in southern China and tested whether obesity mediated this association.

Methods: A total of 14,308 adults from 48 communities/villages in southern China were selected from January 2015 to December 2015 using a stratified multistage random sampling method. Hourly PM2.5 measurements were collected from the China National Environmental Monitoring Centre. Restricted cubic splines were used to analyze the nonlinear dose-response relationship between PM2.5 exposure and hypertension risk. The mediating effect mechanism of obesity on PM2.5-associated hypertension was tested in a causal inference framework following the approach proposed by Imai and Keele.

Results: A total of 20.7% (2966/14,308) of participants in the present study were diagnosed with hypertension. Nonlinear exposure-response analysis revealed that exposure to an annual mean PM2.5 concentration above 41.8 µg/m3 was associated with increased hypertension risk at an incremental gradient. 9.1% of the hypertension burden could be attributed to exposure to elevated annual average concentrations of PM2.5. It is noteworthy that an increased body fat percentage positively mediated 59.3% of the association between PM2.5 exposure and hypertension risk, whereas body mass index mediated 34.3% of this association.

Conclusions: This study suggests that a significant portion of the estimated effect of exposure to PM2.5 on the risk of hypertension appears to be attributed to its effect on alterations in body composition and the development of obesity. These findings could inform intersectoral actions in future studies to protect populations with excessive fine particle exposure from developing hypertension.

Keywords: Body Fat percentage; Hypertension; Mediating Effect; Particulate matter; Population-attributable risk fraction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The flow chart of the study population selection
Fig. 2
Fig. 2
Geographic location and 12-month average PM2.5 exposure levels of 14 308 participants from 48 communities or villages in south China in 2015. The blue dot represented a single selected community or village
Fig. 3
Fig. 3
Concentration-response curves for the effects of ambient PM2.5(A), age (B), and body mass index (C) on hypertension. OR means odds ratio. Distribution of Propensity score (D) of participants before and after matching
Fig. 4
Fig. 4
It was estimated that body fat percentage (A) mediated the highest association between PM2.5 concentration and hypertension, over body mass index (B), waist circumference (C), and weight (D). ACME, average causal mediation effects. ADE, average direct effects
See this image and copyright information in PMC

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