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Association of fat-to-muscle ratio with hypertension: a cross-sectional study in China

Journal of Human Hypertension volume 39, pages 301–307 (2025)Cite this article

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Abstract

This study investigated the association between fat-to-muscle ratio (FMR) and hypertension. A total of 1592 participants aged ≥ 40 years were included. Participants were divided into four groups by quartiles of FMR. Odds ratio (OR) and 95% confidence interval (CI) was calculated using logistic regression models. Restricted cubic spline was applied to examine the correlation of FMR and hypertension. Of 1592 participants, 943 (59.2%) participants had hypertension. Hypertension risk rose with FMR quartiles. Compared to FMR quartile 1, ORs were 1.496 (95% CI: 1.115–2.006), 2.445 (95% CI: 1.840–3.249), and 5.415 (95% CI: 3.993–7.344) for quartiles 2, 3, and 4, respectively (P for trend < 0.001). Adjusted OR in quartile 4 was 3.015 (95% CI: 2.083–4.365). Restricted cubic spline showed a linear relationship between FMR and hypertension. Adding FMR improved hypertension risk model performance (P = 0.006). Subgroup analysis revealed FMR interactions with sex (P = 0.010) and BMI (P < 0.016), with a higher hypertension risk in females and non-obese individuals. Additionally, versus FMR quartile 1, hypertensive individuals in quartiles 2 (OR: 1.370, 95% CI: 0.900–2.085), 3 (OR: 2.055, 95% CI: 1.374–3.073) and 4 (OR: 3.102, 95% CI: 2.055–4.682) exhibited a significantly elevated risk of atherosclerotic cardiovascular disease (ASCVD). In summary, Elevated FMR independently correlated with hypertension risk, especially in women, or even in non-obese individuals. FMR is a valuable tool for identifying populations with higher hypertension risk and assessing ASCVD risk in hypertensive individuals. Body composition warrants consideration in future hypertension risk studies.

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Fig. 1: The relationship between fat-to-muscle ratio and risk of hypertension based on restricted cubic spines with 5 knots at 5th, 25th, 50th, 75th, and 95th percentiles among participants.

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Data availability

The original data of this study are available from Dryad Digital Repository (https://datadryad.org).

References

  1. Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16:223–37.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Lu J, Lu Y, Wang X, Li X, Linderman GC, Wu C, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390:2549–58.

    Article  PubMed  Google Scholar 

  3. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18:785–802.

    Article  PubMed  PubMed Central  Google Scholar 

  4. The Lancet Neurology. The global challenge of hypertension. Lancet Neurol. 2023;22:1087.

    Article  PubMed  CAS  Google Scholar 

  5. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am. 2009;93:733–51.

    Article  PubMed  CAS  Google Scholar 

  7. Zeng Q, Sun L, Zeng Q. Trajectories of mid-life to elderly adulthood BMI and incident hypertension: the China Health and Nutrition Survey. BMJ Open. 2021;11:e047920.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr. 2022;41:990–1000.

    Article  PubMed  CAS  Google Scholar 

  9. Park SH, Park JH, Song PS, Kim DK, Kim KH, Seol SH, et al. Sarcopenic obesity as an independent risk factor of hypertension. J Am Soc Hypertens. 2013;7:420–5.

    Article  PubMed  Google Scholar 

  10. Ramirez-Velez R, Carrillo HA, Correa-Bautista JE, Schmidt-RioValle J, Gonzalez-Jimenez E, Correa-Rodriguez M, et al. Fat-to-Muscle ratio: a new anthropometric indicator as a screening tool for metabolic syndrome in young Colombian people. Nutrients. 2018;10:1027.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liu D, Zhong J, Ruan Y, Zhang Z, Sun J, Chen H. The association between fat-to-muscle ratio and metabolic disorders in type 2 diabetes. Diabetol Metab Syndr. 2021;13:129.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Eun Y, Lee SN, Song SW, Kim HN, Kim SH, Lee YA, et al. Fat-to-muscle ratio: a new indicator for coronary artery disease in healthy adults. Int J Med Sci. 2021;18:3738–43.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Gortan Cappellari G, Guillet C, Poggiogalle E, Ballesteros Pomar MD, Batsis JA, Boirie Y, et al. Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) - proceedings from the SOGLI consortium meeting in rome November 2022. Clin Nutr. 2023;42:687–99.

    Article  PubMed  Google Scholar 

  14. Yan F, Nie G, Zhou N, Zhang M, Peng W. Association of fat-to-muscle ratio with non-alcoholic fatty liver disease: a single-centre retrospective study. BMJ Open. 2023;13:e072489.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Fang Q, Zhu G, Huang J, Pan S, Fang M, Li Q, et al. Current status of sarcopenia in the disabled elderly of chinese communities in Shanghai: based on the updated EWGSOP consensus for sarcopenia. Front Med. 2020;7:552415.

    Article  Google Scholar 

  16. Zeng P, Wu S, Han Y, Liu J, Zhang Y, Zhang E, et al. Differences in body composition and physical functions associated with sarcopenia in chinese elderly: reference values and prevalence. Arch Gerontol Geriatr. 2015;60:118–23.

    Article  PubMed  Google Scholar 

  17. Sun Q, Cui J, Liu W, Li J, Hong M, Qian S. The prognostic value of sarcopenia in acute myeloid leukemia patients and the development and validation of a novel nomogram for predicting survival. Front Oncol. 2022;12:828939.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhu J, Zhang Y, Wu Y, Xiang Y, Tong X, Yu Y, et al. Obesity and dyslipidemia in chinese adults: A Cross-Sectional Study in Shanghai, China. Nutrients. 2022;14:2321.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Andrus B, Lacaille D. 2013 ACC/AHA guideline on the assessment of cardiovascular risk. J Am Coll Cardiol. 2014;63:2886.

    Article  PubMed  Google Scholar 

  20. Ittermann T, Werner N, Lieb W, Merz B, Nothlings U, Kluttig A, et al. Changes in fat mass and fat-free-mass are associated with incident hypertension in four population-based studies from Germany. Int J Cardiol. 2019;274:372–7.

    Article  PubMed  Google Scholar 

  21. Sato F, Maeda N, Yamada T, Namazui H, Fukuda S, Natsukawa T, et al. Association of epicardial, visceral, and subcutaneous fat with cardiometabolic diseases. Circ J. 2018;82:502–8.

    Article  PubMed  CAS  Google Scholar 

  22. Goto K, Yokokawa H, Fukuda H, Saita M, Hamada C, Hisaoka T, et al. An association between subcutaneous fat mass accumulation and hypertension. J Gen Fam Med. 2021;22:209–17.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Takase M, Nakamura T, Tsuchiya N, Kogure M, Itabashi F, Narita A, et al. Association between the combined fat mass and fat-free mass index and hypertension: The Tohoku Medical Megabank Community-based Cohort Study. Clin Exp Hypertens. 2021;43:610–21.

    Article  PubMed  Google Scholar 

  24. Lee SB, Cho AR, Kwon YJ, Jung DH. Body fat change and 8-year incidence of hypertension: Korean Genome and Epidemiology Study. J Clin Hypertens. 2019;21:1849–57.

    Article  Google Scholar 

  25. Jurdana M, Ziberna L. Sarcopenic obesity and hypertension in elderly patients: a narrative review of pathophysiology and management strategies. Ann Ist Super Sanita. 2023;59:231–9.

    PubMed  CAS  Google Scholar 

  26. Seravalle G, Grassi G. Obesity and hypertension. Pharmacol Res. 2017;122:1–7.

    Article  PubMed  CAS  Google Scholar 

  27. Butcher JT, Mintz JD, Larion S, Qiu S, Ruan L, Fulton DJ, et al. Increased muscle mass protects against hypertension and renal injury in obesity. J Am Heart Assoc. 2018;7:e009358.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gao LW, Huang YW, Cheng H, Wang X, Dong HB, Xiao P, et al. Prevalence of hypertension and its associations with body composition across chinese and american children and adolescents. World J Pediatr. 2024;20:392–403.

  29. Chen YY, Fang WH, Wang CC, Kao TW, Yang HF, Wu CJ, et al. Fat-to-muscle ratio is a useful index for cardiometabolic risks: a population-based observational study. PLoS One. 2019;14:e0214994.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Park SK, Ryoo JH, Oh CM, Choi JM, Chung PW, Jung JY. Body fat percentage, obesity, and their relation to the incidental risk of hypertension. J Clin Hypertens. 2019;21:1496–504.

    Article  CAS  Google Scholar 

  31. Yan F, Nie G, Zhou N, Zhang M, Peng W. Combining fat-to-muscle ratio and alanine aminotransferase/aspartate aminotransferase ratio in the prediction of cardiometabolic risk: A Cross-Sectional Study. Diabetes Metab Syndr Obes. 2023;16:795–806.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  32. Jayant SS, Gupta R, Rastogi A, Agrawal K, Sachdeva N, Ram S, et al. Abdominal obesity and incident cardio-metabolic disorders in Asian-Indians: A 10-years prospective cohort study. Diabetes Metab Syndr. 2022;16:102418.

    Article  PubMed  CAS  Google Scholar 

  33. Marra M, Sammarco R, De Lorenzo A, Iellamo F, Siervo M, Pietrobelli A, et al. Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy X-Ray absorptiometry (DXA): a critical overview. Contrast Media Mol Imaging. 2019;2019:3548284.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors appreciate Yan F, Peng W et al. for sharing the data for secondary analysis.

Author information

Authors and Affiliations

  1. Department of Interventional Ultrasound, Cancer Hospital of Shantou University Medical College, Shantou, China

    Zhe Chen

  2. Department of Interventional Ultrasound, the Second Affiliated Hospital of Shantou University Medical College, Shantou, China

    Dongming Guo & Honghui Su

  3. Department of Emergency, Cancer Hospital of Shantou University Medical College, Shantou, China

    Lifeng Xiao

  4. Department of Critical Care Medicine, the Second Affiliated Hospital of Shantou University Medical College, Shantou, China

    Yirun Chen

  5. Department of Critical Care Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China

    Yirun Chen

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Contributions

LX and ZC were responsible for manuscript writing and data analysis. YC conceived and supervised the study. DG and YC contributed to literature search and methodology. HS performed the manuscript review. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yirun Chen.

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Ethics approval

The original study, the source of our research data, involved human participants and was approved by the Institutional Review Board of Tongji Medical College, Huazhong University of Science and Technology. The protocol of this study was approved by the Ethics Committee of Cancer Hospital of Shantou University Medical College. No informed consent was required because the study was conducted retrospectively and anonymized.

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The authors declare no competing interests.

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Chen, Z., Guo, D., Xiao, L. et al. Association of fat-to-muscle ratio with hypertension: a cross-sectional study in China. J Hum Hypertens 39, 301–307 (2025). https://doi.org/10.1038/s41371-025-00992-z

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