The results show that participants with larger body dimensions also had higher BP as indicated by the correlation values. In particular, as WC increased, so did BP (see r values in Table 2). Also, the differences in measurements of body size between the group with elevated BP and those with normal BP were moderately large, except for WC/HPC (Table 1). This is consistent with many previous reports 29–31. However, compared with findings 21,22,32–35 in non-Nigerian groups, particularly African–Americans and whites, the present association between BP and body size indicators appears weak. Even so, the present correlation values were higher than those for age (0.05), BMI (0.088) and WC (0.061) reported by Onwubere et al. 31 in another Nigerian traditional community of a different ethnicity with a prevalence of hypertension of 46.4% compared with 33.1% found in this study. This weak or lack of a relationship between body dimensions and BP has also been observed in other groups particularly within Africa 7,9,29–31,36–38. It should be noted that nearly two-thirds of individuals with elevated BP had a BMI of less than 25 kg/m2, thereby indicating that the dominant body type associated with hypertension in this group was lean. This is consistent with the findings of independent investigators 7,9,36–38. The corollary to this is that about a quarter (26.1%) of those with normal BP were overweight, thus showing that larger body sizes were not always associated with elevated BP in every group 36,39–41.
Importantly, the regression analyses showed that BMI or WC did not have the same effects on BP in all participants. In particular, the functional relationship between SBP and BMI, with a constant of 1.103 and an R2 value of 0.046 in older participants (≥50 years), was comparable with 1.17 and R2 of 0.050 reported by Cappuccio et al.30 from the same ethnic group and region, albeit in men. Interestingly, these quantitative effects of BMI and WC on SBP disappeared once BP was elevated as indicated by a P value of 0.101 of the functional relationship between BP and indicators of body dimensions in the group with elevated BP (see the Results section and Fig. 1). This could mean that the effects of body size on BP may depend on age and whether or not hypertension was present.
Furthermore, the results from the different methods used in the analysis of the present data consistently showed that BMI and WC were rather poor predictors of BP. This consistency reinforces our interpretation that body size was unlikely to be a major determinant of BP in this group, suggesting that differences in body dimensions may not be of major relevance in the determination of BP level in everyperson or group, especially when hypertension is present as others have also argued 7,9,39–43.
Nevertheless, the data also show that large body sizes may be a valuable social asset in these communities as reported widely 10–16 in many black groups of diverse geographic locations and ethnicity. More recent studies 25,54 overseas, however, suggest that in some black groups, up to 80% of participants may prefer thinner body figures. One study 55 reported that the majority of young women in one university campus in Nigeria prefer slimmer figures, even when of normal size. These studies cited above mainly involved elites attempting to lose weight for health/beauty reasons and were in settings where intense media exposure was likely, unlike in the present study group 19, who were less educated and living traditionally. Together, these reports could indicate a possible cultural shift towards a more pervasive notion of beauty/health as thinner is better. Even so, it is to be noted that younger and, sometimes, older women are known to undergo a fattening process to improve appearance (as part of marriage/coming-of-age-rites, etc.) in several ethnic groups, for example, Efik, Ibani-Ijaw, Kalabari, Ogori, Boki, etc. in contemporary Nigeria 56–58.
These findings have implications for future research in raising a number of important issues of relevance to the prevention/control of hypertension. First, if the indicators of body size (BMI) and shape (WC) play such a minimal role in the variation in BP of adults in these communities, as this study strongly suggests, then it means that we do not know why the majority of those with elevated BP are those who are lean and why others, overweight, have normal BP. Second, preference for a particular body size can be a powerful motivation for weight-control behaviour in that an individual who desires a larger body size may be less inclined to lose weight. Weight-based interventions have been recommended to control/prevent hypertension. The relevance of a desire for larger body sizes as it relates to possible effects of weight reduction on individuals’ perception of body size is not clear as this is rarely monitored. Unfortunately, the cross-sectional nature of our study is a major limitation in answering these important questions including making any possible inference on causality from the present data set. To this extent, longitudinal studies are needed to investigate the interaction between indicators of body size/shape, perception of body size and BP in the absence/presence of a family history of hypertension, preferably beginning in early childhood.
Finally, irrespective of these limitations, the present study strengthens our earlier conclusion 18,19 that a dominant notion of physical beauty that favourably views excess weight, as defined by the European standard, exists in this group. The data also showed that body size and/or its perception contributed towards the variance in BP between individuals, but only nominally so. Consequently, if these observations are confirmed in longitudinal studies, they could alter the standard view that a large body size or an increasing body size is fundamental to the increasing incidence of hypertension in Nigeria, at least in some traditional groups.
A substantial part of the work was carried out during a sabbatical leave in Niger Delta University in Wilberforce Island, Bayelsa State, Nigeria. We thank Drs P.M. Kolo, A.D. Chijioke, H.O. Sholagberu and S.A. Adebisi for their help in organizing the logistics that facilitated field work and data acquisition. The study was partly funded by a small grant from the University of Ilorin Teaching Hospital.
This work is dedicated with gratitude to Marie Lindquist, PhD, for her untiring efforts in advancing pharmacovigilance for better treatment outcome in several developing countries including Nigeria.
E.O. Okoro conceptualized and designed the study with B.A. Oyejola, who also analysed the results. Data interpretation was carried out by E.O. Okoro, E.N. Etebu and B.A. Oyejola. Dr E.N. Etebu wrote the initial draft, which was reviewed by E.O. Okoro. Thereafter, all authors read the material and made critical inputs to the final manuscript.
There are no conflicts of interest.
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