Association Between Skeletal Muscle Mass to Visceral Fat Area Ratio and Hypertension: Mediation Analysis Involving Body Mass Index in the NHANES.

Abstract

Introduction: Body composition has emerged as a critical modulator of cardiovascular risk, and hypertension continues to be a significant public health concern. By combining harmful visceral fat with metabolically protective muscle, the skeletal muscle mass-to-visceral fat area ratio (SVR) may offer new insights into the pathophysiology of hypertension. The purpose of this study was to look into the mechanisms underlying the association between SVR and hypertension.

Methods: Data from the National Health and Nutrition Examination Survey (2011-2018), which included 6,934 participants (27.2% of whom had hypertension), were analyzed in this cross-sectional study. The relationship between SVR and hypertension was investigated using Restricted Cubic Splines (RCS) and multivariable logistic regression. Mediation analysis was used to evaluate the impact of BMI. Gender, race, physical activity (Metabolic Equivalent of Task [MET] categories), metabolic comorbidities (diabetes, depression), smoking, and alcohol use were all subgroups analyzed.

Results: Hypertensive individuals had significantly lower SVR (P < 0.001). After adjustments, a strong inverse association between SVR and hypertension was found. Individuals in the highest SVR quartile had 46% lower odds of hypertension (OR = 0.54, 95% CI: 0.36-0.82; P for trend < 0.004). RCS analysis revealed a nonlinear negative relationship between SVR and hypertension (P < 0.001) and a nonlinear positive association between BMI and hypertension (P < 0.001). Subgroup analyses indicated that the association persisted in metabolically healthy individuals (non-diabetic, non-depressed), Non-Hispanic White participants, moderate and heavy drinkers, and those with high MET levels (P < 0.05), but not in individuals with diabetes, depression, other racial/ethnic groups, light drinkers, or low-MET groups. Smoking significantly modified the relationship. BMI mediated 40.85% of the SVR-hypertension effect (P < 0.001).

Discussion: This study is the first to explore the relationship between SVR and hypertension. A strong inverse correlation exists between SVR and the incidence of hypertension. The association between SVR and hypertension is stronger than that with BMI. A low SVR may amplify metabolic disorders through the synergistic effects of muscle mass and visceral fat. Although further experimental validation is still needed, these findings may provide new intervention strategies for the prevention of hypertension.

Conclusion: Higher SVR is associated with a lower incidence of hypertension. As a composite measure of both skeletal muscle mass and visceral fat area, SVR provides more comprehensive insights into the link between body composition and high blood pressure.