Perirenal fat area is a preoperative predictor of hypertension resolution after laparoscopic sleeve gastrectomy: Generalized additive models

doi:10.3748/wjg.v31.i12.104952

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Mar 28, 2025 (publication date) through Apr 3, 2025

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World Journal of Gastroenterology

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World J Gastroenterol. Mar 28, 2025; 31(12): 104952
Published online Mar 28, 2025. doi: 10.3748/wjg.v31.i12.104952

Table 1 Baseline characteristics of patients and their correlation with hypertension resolution, n (%)

Basic information	Resolved	Unresolved	OR (95%CI)	P value
Age (years)	33.1 ± 9.3	35.3 ± 8.1	0.973 (0.931-1.017)	0.226
Gender			1.785 (0.792-4.197)	0.170
Male	54 (50.5)	20 (64.5)
Female	53 (49.5)	11 (35.5)
Obesity duration (years)	6.3 ± 6.9	9.1 ± 7.3	0.951 (0.898-1.002)	0.063
Related diseases
T2DM	58 (54.2)	21 (67.7)	0.564 (0.234-1.285)	0.183
Hyperlipidemia	50 (46.7)	19 (61.3)	0.554 (0.24-1.241)	0.156
NAFLD	97 (90.7)	28 (90.3)	1.039 (0.222-3.675)	0.956
OSAHS	77 (72.0)	23 (74.2)	0.893 (0.343-2.15)	0.807
Hyperuricemia	52 (48.6)	20 (64.5)	0.52 (0.221-1.172)	0.121
Physical examination
SBP (mmHg)	152.7 ± 11.7	158 ± 13.3	0.966 (0.935-0.998)	0.038
DBP (mmHg)	94.9 ± 12.7	97.9 ± 13.3	0.982 (0.95-1.013)	0.260
BMI (kg/m²)	42.2 ± 7	45.1 ± 8.8	0.951 (0.902-1.002)	0.060
Waist circumference (cm)	127.7 ± 15.1	134.5 ± 17.5	0.974 (0.949-0.999)	0.040
Hip circumference (cm)	130.9 ± 13.8	136 ± 17	0.977 (0.95-1.004)	0.089
Waist-to-hip ratio	1 ± 0.1	1 ± 0.1	0.051 (0-21.548)	0.338
Blood tests
HbA1c (%)	6.7 ± 1.3	6.8 ± 1.3	0.908 (0.683-1.232)	0.512
HOMA-IR	11.9 ± 8.1	13.8 ± 10.3	0.977 (0.936-1.022)	0.286
ALT (U/L)	51.2 ± 41.6	48.6 ± 43.6	1.002 (0.992-1.013)	0.761
AST (U/L)	28.5 ± 17.9	34.7 ± 25.6	0.986 (0.968-1.005)	0.136
AST/ALT	0.6 ± 0.2	0.8 ± 0.4	0.058 (0.008-0.307)	0.002
Creatinine (μmol/L)	66.2 ± 23.4	67.8 ± 18.6	0.997 (0.98-1.015)	0.719
eGFR	116.1 ± 33.2	118.6 ± 19	0.997 (0.981-1.01)	0.694
Uric acid (μmol/L)	391.6 ± 152	454.9 ± 102.4	0.997 (0.993-1)	0.034
Sodium (mmol/L)	136.3 ± 13.6	140.5 ± 2.5	0.81 (0.66-0.958)	0.033
Triglyceride (mmol/L)	2.3 ± 2.1	2.5 ± 2.8	0.972 (0.832-1.182)	0.730
Total cholesterol (mmol/L)	4.5 ± 1.2	5 ± 0.9	0.641 (0.412-0.947)	0.035
HDL-CH (mmol/L)	1.1 ± 0.4	1 ± 0.2	2.721 (0.747-15.931)	0.198
LDL-CH (mmol/L)	2.8 ± 1	3.2 ± 0.8	0.562 (0.325-0.913)	0.028
ApoA1:ApoB	3.7 ± 11	1 ± 0.5	2.445 (1.147-9.909)	0.172
ApoE (mg/L)	50 ± 17.9	50.8 ± 11.6	0.997 (0.974-1.022)	0.819
Homocysteine (μmol/L)	13.7 ± 8.5	17.4 ± 9.8	0.96 (0.919-1.001)	0.053
FT3 (pmol/L)	5.8 ± 2.6	5.4 ± 0.9	1.299 (0.924-2.24)	0.323
FT4 (pmol/L)	19.2 ± 14.4	17.8 ± 2.3	1.018 (0.979-1.166)	0.658
Renin	36.8 ± 60.6	42.2 ± 90.5	0.999 (0.994-1.005)	0.699
Angiotensin II	43.5 ± 21.3	39.9 ± 17.4	1.009 (0.989-1.032)	0.388
Aldosterone	11.8 ± 7.6	13.9 ± 11.3	0.975 (0.934-1.019)	0.239
ACTH (pg/mL)	36.1 ± 24.1	32.3 ± 22.5	1.007 (0.99-1.028)	0.432
Cortisol at 8:00 am (nmol/L)	309.8 ± 131.6	356.3 ± 115.8	0.997 (0.994-1)	0.080
CT measurements
PrFA (cm²)	19 ± 10.5	30.5 ± 16	0.934 (0.901-0.965)	< 0.001
PrFT (cm)	1.4 ± 0.9	2.1 ± 1.3	0.551 (0.369-0.802)	0.002
Visceral fat area (cm²)	198.4 ± 89.7	262.6 ± 105.8	0.993 (0.989-0.997)	0.002
Total fat area (cm²)	576.4 ± 175.1	645.7 ± 178.3	0.998 (0.996-1)	0.058

Univariate logistic regression models were used to recognize the correlation of baseline characteristics with hypertension resolution. Data are expressed by quantity (rate) or mean ± SD. OR: Odds ratio; CI: Confidence interval; T2DM: Type 2 diabetes mellitus; NAFLD: Non-alcoholic fatty liver disease; OSAHS: Obstructive sleep apnea-hypopnea syndrome; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; HbA1c: Glycated hemoglobin A1c; HOMA-IR: Homeostasis model assessment-insulin resistance; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; eGFR: Estimated glomerular filtration rate; HDL-CH: High-density lipoprotein cholesterol; LDL-CH: Low-density lipoprotein cholesterol; ApoA1: Apolipoprotein A1; ApoB: Apolipoprotein B; ApoE: Apolipoprotein E; FT3: Free triiodothyronine; FT4: Free thyroxine; ACTH: Adrenocorticotropic hormone; CT: Computed tomography; PrFA: Perirenal fat area; PrFT: Perirenal fat thickness.

Table 2 Both perirenal fat area and perirenal fat thickness are independent predictors of hypertension resolution after surgery

	OR (95%CI)¹	P value¹	OR (95%CI)²	P value²
BMI (kg/m²)	1.118 (0.94-1.325)	0.194	1.106 (0.962-1.285)	0.162
SBP (mmHg)	0.931 (0.877-0.982)	0.013	0.946 (0.896-0.994)	0.036
AST/ALT	0.001 (0-0.029)	< 0.001	0.005 (0-0.056)	< 0.001
Sodium (mmol/L)	0.718 (0.535-0.935)	0.018	0.737 (0.559-0.946)	0.021
PrFA (cm²)	0.887 (0.831-0.937)	< 0.001	-	-
PrFT (cm)	-	-	0.375 (0.192-0.688)	0.002

¹Analysis containing only perirenal fat area.

²Analysis containing only perirenal fat thickness.

Multivariable logistic regression models including perirenal fat thickness or perirenal fat area respectively were constructed to recognize the independent risk factors of hypertension resolution. OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; SBP: Systolic blood pressure; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PrFA: Perirenal fat area; PrFT: Perirenal fat thickness.

Table 3 The predictive value of perirenal fat area is superior to that of perirenal fat thickness

Fold	GAM (PrFA)	GAM (PrFT)
1	0.835 (0.669-1.000)	0.918 (0.817-1.000)
2	0.694 (0.443-0.945)	0.646 (0.371-0.922)
3	0.979 (0.932-1.000)	0.896 (0.771-1.000)
4	0.806 (0.547-1.000)	0.736 (0.554-0.918)
5	0.918 (0.792-1.000)	0.850 (0.704-0.997)
Mean	0.846 (0.676-0.989)	0.809 (0.643-0.967)

Fivefold cross-validation was used to evaluate the prediction accuracy of different generalized additive models including perirenal fat area or perirenal fat thickness respectively. GAM: Generalized additive model; PrFA: Perirenal fat area; PrFT: Perirenal fat thickness.

Table 4 Patients with lower perirenal fat area have higher rates of hypertension resolution after surgery, n (%)

	PrFA < 18 cm²	PrFA ≥ 18 cm²	P value	^adjOR (95%CI)	^adjP value
Patients number	69	69
Age	33.2 ± 10.1	33.9 ± 7.9	0.673
Gender
Male	23.2 (16)	84.1 (58)
Female	76.8 (53)	15.9 (11)	< 0.001
Obesity duration (years)	7.8 ± 8	5.9 ± 5.9	0.114
NAFLD	61 (88.4)	64 (92.8)	0.382
OSAHS	49 (71)	51 (73.9)	0.703
SBP (mmHg)	154.3 ± 12.4	153.5 ± 12.1	0.709
DBP (mmHg)	95.5 ± 12.9	95.7 ± 12.9	0.937
BMI (kg/m²)	40.8 ± 7.3	44.9 ± 7.2	0.001
Waist circumference (cm)	123.4 ± 14.8	135.1 ± 14.8	< 0.001
Hip circumference (cm)	129.7 ± 13.9	134.3 ± 15.2	0.064
Waist-to-hip ratio	0.952 ± 0.064	1.008 ± 0.057	< 0.001
HbA1c (%)	6.8 ± 1.5	6.6 ± 1.1	0.520
HOMA-IR	11.7 ± 8.3	12.9 ± 9	0.425
ALT/AST	0.7 ± 0.3	0.6 ± 0.2	0.058
Creatinine (μmol/L)	62.2 ± 22.9	70.9 ± 21	0.021
Uric acid (μmol/L)	373.6 ± 146	438.1 ± 136.5	0.008
Sodium (mmol/L)	137.4 ± 9	137.2 ± 14.6	0.924
Triglyceride (mmol/L)	2.4 ± 2.5	2.3 ± 2.1	0.809
Total cholesterol (mmol/L)	4.6 ± 1.3	4.7 ± 1	0.643
HDL-CH (mmol/L)	1.1 ± 0.4	1.1 ± 0.3	0.311
LDL-CH (mmol/L)	2.8 ± 1	3 ± 0.8	0.204
Renin	40.4 ± 72.7	35.6 ± 63.6	0.677
Angiotensin II	47.1 ± 24	38.3 ± 15.3	0.011
Aldosterone	11.8 ± 8	12.8 ± 9.1	0.476
Cortisol at 8:00 am (nmol/L)	320.9 ± 140.7	319.5 ± 117.9	0.949
PrFA (cm²)	11.6 ± 4	31.5 ± 10.8	< 0.001
Visceral fat area (cm²)	149.5 ± 57.4	276.2 ± 86.6	< 0.001
Total fat area (cm²)	528.3 ± 183.3	655.6 ± 147.2	< 0.001
Postoperative resolution of hypertension	60 (87)	47 (68.1)	0.008	3.513 (1.367-9.902)	0.012

Multivariable logistic regression models were constructed using covariates such as preoperative systolic blood pressure to recognize the correlation of grouping and hypertension resolution. Data are expressed by quantity (rate) or mean ± SD. OR: Odds ratio; CI: Confidence interval; NAFLD: Non-alcoholic fatty liver disease; OSAHS: Obstructive sleep apnea-hypopnea syndrome; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; BMI: Body mass index; HbA1c: Glycated hemoglobin A1c; HOMA-IR: Homeostasis model assessment-insulin resistance; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HDL-CH: High-density lipoprotein cholesterol; LDL-CH: Low-density lipoprotein cholesterol; PrFA: Perirenal fat area.

Citation: Li Y, Zheng KY, Liu ZL, Yu TM, Zhang WJ, Zhong MW, Hu SY. Perirenal fat area is a preoperative predictor of hypertension resolution after laparoscopic sleeve gastrectomy: Generalized additive models. World J Gastroenterol 2025; 31(12): 104952
URL: https://www.wjgnet.com/1007-9327/full/v31/i12/104952.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i12.104952