Obesity, Sarcopenia, Sarcopenic Obesity, and Hypertension: Mediating Role of Inflammation and Insulin Resistance

Abstract Background This study aimed to assess the association between obesity, sarcopenia, and sarcopenic obesity with hypertension and to explore the potential mediation of inflammation indicators and insulin resistance. Methods Data from the UK Biobank, a large-scale prospective cohort, were utilized. Obesity was defined using percentage of fat mass, whereas sarcopenia was defined as low muscle mass and low muscle strength. The primary outcome assessed was new-onset hypertension within a 5-year follow-up period. The association analysis was examined using a Cox regression model. Results A total of 183 091 participants were enrolled in this study. During 5 years of follow-up, 3 812 (2.08%) developed hypertension. In the fully adjusted model, compared to men without these conditions, those with obesity, sarcopenia, and sarcopenic obesity had 2.32 times (95% confidence interval [95% CI], 2.12–2.55), 3.10 times (95% CI, 2.35–4.08), and 3.66 times (95% CI, 2.98–4.50) higher risks of developing hypertension, respectively. Women with obesity, sarcopenia, and sarcopenic obesity had 2.27 times (95% CI, 2.03–2.54), 2.93 times (95% CI, 1.95–4.39), and 4.04 times (95% CI, 3.32–4.91) higher risks of hypertension, respectively. Significant mediating effects of C-reactive protein, neutrophils, white blood cells, triglyceride-glucose index, and triglyceride-to-high-density lipoprotein cholesterol ratio were found, with mediations ranging from 6% to 13% for men and 2% to 21% for women in the association between sarcopenic obesity and hypertension. Conclusions Obesity, sarcopenia, and sarcopenic obesity significantly increased the risk of hypertension. Inflammation and insulin resistance appeared to mediate the association between sarcopenic obesity and hypertension.