Association of Hypertension, Body Mass Index, and Waist Circumference with Fluoride Intake; Water Drinking in Residents of Fluoride Endemic Areas, Iran

  • Mahmood Yousefi
  • Mehdi Yaseri
  • Ramin Nabizadeh
  • Elham Hooshmand
  • Mohsen Jalilzadeh
  • Amir Hossein Mahvi
  • Ali Akbar Mohammadi


Hypertension is becoming a global epidemic for both rural and urban populations; it is a major public health challenge in Iran. Fluoride can be a risk factor for hypertension. Cross-sectional analysis was conducted in two study areas to assess the relation of fluoride with blood pressure prevalence, BMI, waist circumference, and waist-to-hip ratio (WHR) among different age groups in both sexes. The mean value of fluoride concentration in the drinking water from the four study villages varied from 0.68 to 10.30 mg/L. The overall prevalence of HTN and prehypertension in all subjects was 40.7%. The prevalence of isolated systolic hypertension, isolated diastolic hypertension, systolic-diastolic hypertension, and prehypertension in the total sample population was 1.15, 0.28, 9.53, and 29.76%, respectively. The odd ratio of hypertension in residents who drank water with high fluoride levels was higher than that in residents who drank water with lower level of fluoride (OR 2.3, 1.03–5.14). Logistic regression results showed that age (P < 0.001), sex (P = 0.018), BMI (P = 0.015), and the fluoride level in drinking water (P = 0.041) had a significant relationship with increased blood pressure. There were no statistically significant correlations between fluoride and BMI, hip circumference, and waist to hip ratio (WHR). The findings of this study are important for health care personnel and policymakers.


Drinking water Fluoride endemic Hypertension BMI Poldasht Iran 



Isolated systolic hypertension


Diastolic blood pressure


Isolated diastolic hypertension


waist-to-hip ratio


Systolic-diastolic hypertension


Mean Arterial Pressure




Total dissolved solids




Total hardness




Body mass index


Systolic blood pressure


World Health Organization



The authors want to thank the authorities of Neyshabur University of Medical Sciences and Poldasht Health Centre Department for their comprehensive support for this study.

Compliance with Ethical Standards

Competing Interests

The authors declare that they have no competing interests.


  1. 1.
    Taghipour N, Amini H, Mosaferi M, Yunesian M, Pour Akbar M, Taghipour H (2016) National and sub-national drinking water fluoride concentrations and prevalence of fluorosis and of decayed, missed, and filled teeth in Iran from 1990 to 2015: a systematic review. Environ Sci Pollut Res 23:5077–5098CrossRefGoogle Scholar
  2. 2.
    Quispe D, Pérez-López R, Silva LFO, Nieto JM (2012) Changes in mobility of hazardous elements during coal combustion in Santa Catarina power plant (Brazil). Fuel 94:495–503CrossRefGoogle Scholar
  3. 3.
    Yousefi M, Mohammadi AA, Yaseri M, Mahvi AH (2017) Epidemiology of fluoride and its contribution to fertility, infertility, and abortion: an ecological study in West Azerbaijan Province, Poldasht County, Iran. Fluoride 50:343–353Google Scholar
  4. 4.
    Mohammadi AA, Yousefi M, Yaseri M, Jalilzadeh M, Mahvi AH (2017) Skeletal fluorosis in relation to drinking water in rural areas of West Azerbaijan, Iran. Sci Rep 7:17300CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Spittle B (2017) The effect of the fluoride ion on reproductive parameters and an estimate of the safe daily dose of fluoride to prevent female infertility and miscarriage, and foetal neurotoxicity. Fluoride 50:287–229Google Scholar
  6. 6.
  7. 7.
    Mohammadi AA, Yousefi M, Mahvi AH (2017) Fluoride concentration level in rural area in Poldasht city and daily fluoride intake based on drinking water consumption with temperature. Data Brief 13:12–315CrossRefGoogle Scholar
  8. 8.
    Amouei AI, Mahvi AH, Mohammadi AA, Asgharnia HA, Fallah SH, Khafajeh AA (2012) Physical and chemical quality assessment of potable groundwater in rural areas of Khaf, Iran. World Appl Sci J18:693–697Google Scholar
  9. 9.
    Amouei A, Mahvi A, Mohammadi A, Asgharnia H, Fallah S, Khafajeh A (2012) Fluoride concentration in potable groundwater in rural areas of Khaf city, Razavi Khorasan province, Northeastern Iran. Int J Occup Environ Med 3:201–203PubMedGoogle Scholar
  10. 10.
    Faraji H, Mohammadi AA, Akbari-Adergani B, Saatloo NV, Lashkarboloki G, Mahvi AH (2014) Correlation between fluoride in drinking water and its levels in breast milk in Golestan Province, Northern Iran. Iran J Public Health 43:1664PubMedPubMedCentralGoogle Scholar
  11. 11.
    Varol E, Aksoy F, Icli A, Arslan A, Yuksel O, Ersoy IH, Varol S, Dogan A (2012) Increased plasma neopterin and hs-CRP levels in patients with endemicfluorosis. Bull Environ Contam Toxicol 89:931–936CrossRefPubMedGoogle Scholar
  12. 12.
    Mesdaghinia A, Vaghefi KA, Montazeri A, Mohebbi MR, Saeedi R (2010) Monitoring of fluoride in groundwater resources of Iran. Bull Environ Contam Toxicol 84:432–437CrossRefPubMedGoogle Scholar
  13. 13.
    Mohammadi AA, Yaghmaeian K, Faraji H, Nabizadeh R, Dehghani MH, Khaili JK, Mahvi AH (2017) Temporal and spatial variation of chemical parameter concentration in drinking water resources of Bandar-e Gaz City using Geographic Information System. Desalin Water Treat 68:170–176CrossRefGoogle Scholar
  14. 14.
    Asghari FB, Mohammadi AA, Aboosaedi Z, Yaseri M, Yousefi M (2017) Data on fluoride concentration levels in cold and warm season in rural area of Shout (West Azerbaijan, Iran). Data Brief 15:528–531CrossRefGoogle Scholar
  15. 15.
    Karimzade S, Aghaei M, Mahvi AH (2014) Investigation of intelligence quotient in 9–12-year-old children exposed to high and low-drinking water fluoride in west Azerbaijan province, Iran. Fluoride 47:9–14Google Scholar
  16. 16.
    Fordyce F, Vrana K, Zhovinsky E, Povoroznuk V, Toth G, Hope B et al (2007) A health risk assessment for fluoride in Central Europe. Environ Geochem Health 29:83–102CrossRefPubMedGoogle Scholar
  17. 17.
    Izquierdo-Vega JA, Sánchez-Gutiérrez M, Del Razo LM (2008) Decreased in vitro fertility in male rats exposed to fluoride-induced oxidative stress damage and mitochondrial transmembrane potential loss. Toxicol Appl Pharmacol 230:352–357CrossRefPubMedGoogle Scholar
  18. 18.
    Chandrajith R, Dissanayake CB, Ariyarathna T, Herath HM, Padmasiri JP (2011) Dose-dependent Na and Ca in fluoride-rich drinking water—another major cause of chronic renal failure in tropical arid regions. Sci Total Environ 409:671–675CrossRefPubMedGoogle Scholar
  19. 19.
    Chattopadhyay A, Podder S, Agarwal S, Bhattacharya S (2011) Fluoride-induced histopathology and synthesis of stress protein in liver and kidney of mice. Arch Toxicol 85:327–335CrossRefPubMedGoogle Scholar
  20. 20.
    Valdez-Jimenez L, Soria Fregozo C, Miranda Beltran ML, Gutierrez Coronado O, Perez Vega MI (2011) Effects of the fluoride on the central nervous system. Neurología (Engl Ed) 26:297–300CrossRefGoogle Scholar
  21. 21.
    Hao P, Ma X, Cheng X, Ba Y, Zhu J, Cui L (2010) Effect of fluoride onhuman hypothalamus–hypophysis–testis axis hormones. Wei Sheng Yan Jiu 39:53–55PubMedGoogle Scholar
  22. 22.
    Seraj B, Shahrabi M, Shadfar M, Ahmadi R (2012) Effect of high water fluoride concentration on the intellectual development of children in Makoo/Iran. J Dent (Tehran, Iran) 9:221–229Google Scholar
  23. 23.
    Yousefi M, Ghoochani M, Mahvi AH (2018) Health risk assessment to fluoride in drinking water of rural residents living in the Poldasht city, Northwest of Iran. Ecotoxicol Environ Saf 148:426–430CrossRefPubMedGoogle Scholar
  24. 24.
    Shashi A, Kumar M, Bhardwaj M (2008) Incidence of skeletal deformities in endemic fluorosis. Trop Dr 38:231–233Google Scholar
  25. 25.
    Mandinic Z, Curcic M, Antonijevic B, Carevic M, Mandic J, Djukic-Cosic D, Lekic CP (2010) Fluoride in drinking water and dental fluorosis. Sci Total Environ 408:3507–3512CrossRefPubMedGoogle Scholar
  26. 26.
    Denbesten P, Li W (2011) Chronic fluoride toxicity: dental fluorosis. Fluoride Oral Environ 22:81–96CrossRefGoogle Scholar
  27. 27.
    Amini H, Shahri SMT, Amini M, Mehrian MR, Mokhayeri Y, Yunesian M (2011) Drinking water fluoride and blood pressure? An environmental study. Biol Trace Elem Res 144:157–163CrossRefPubMedGoogle Scholar
  28. 28.
    Aghaei M, Karimzade S, Yaseri M, Khorsandi H, Zolfi E, Mahvi AH (2015) Hypertension and fluoride in drinking water: case study from west Azerbaijan, Iran. Fluoride 48:252–258Google Scholar
  29. 29.
    Sun L, Gao Y, Liu H, Zhang W, Ding Y, Li B, Li M, Sun D (2013) An assessment of the relationship between excess fluoride intakes from drinking water and essential hypertension in adults residing in fluoride endemic areas. Sci Total Environ 443:864–869CrossRefPubMedGoogle Scholar
  30. 30.
    Liu H, Gao Y, Sun L, Li M, Li B, Sun D (2014) Assessment of relationship on excess fluoride intake from drinking water and carotid atherosclerosis development in adults in fluoride endemic areas, China. Int J Hyg Environ Health 217:413–420CrossRefPubMedGoogle Scholar
  31. 31.
    Newton JN, Young N, Verne J, Morris J (2015) Water fluoridation and hypothyroidism: results of this study need much more cautious interpretation. J Epidemiol Community Health 69:617–618CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Sawana RMM, Leite GAS, Saraiva MC, Barbosa F, Tanus-Santos JE, Gerlach RF (2010) Fluoride increases lead concentrations in whole blood and in calcified tissues from lead-exposed rats. Toxicology 271:21–26CrossRefGoogle Scholar
  33. 33.
    Scarpa M, Vianello F, Riqo A, Viqlino P, Bracco F, Battistin L (1993) Uptake and life time of fluoride ion in rats by 19F-NMR. Magn Reson Imaging 11:697–703CrossRefPubMedGoogle Scholar
  34. 34.
    Xu R, Xu R (1997) Electrocardiogram analysis of patients with skeletal fluorosis. Fluoride 30:16–18Google Scholar
  35. 35.
    Okosun IS, Cooper RS, Rotimi CN, Osotimehin B, Forrester T (1998) Association of waist circumference with risk of hypertension and type 2 diabetes in Nigerians, Jamaicans, and African-Americans. Diabetes Care 21:1836–1842CrossRefPubMedGoogle Scholar
  36. 36.
    Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J (2010) Body mass index, waist circumference and waist: hip ratio as predictors of cardiovascular risk—a review of the literature. Eur J Clin Nutr 64:16–22CrossRefPubMedGoogle Scholar
  37. 37.
    WHO (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163CrossRefGoogle Scholar
  38. 38.
    Sahebnasagh M, Razavi Satvati SA, Motamed Sanaye V, Azani A, Lashkardoost H (2014) Association between body mass index and dental caries in students. J N Khorasan Univ 6:819–828Google Scholar
  39. 39.
    Singh KP, Dash RJ, Varma JS, Singh M, Gauba K, Dhillon MS et al (1998) Incidence of cardiovascular abnormalities in endemic skeletal fluorosis. Fluoride 31:22Google Scholar
  40. 40.
    Varol E, Varol S (2013) Water-borne fluoride and primary hypertension. Fluoride 46:3–6Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mahmood Yousefi
    • 1
    • 2
  • Mehdi Yaseri
    • 3
  • Ramin Nabizadeh
    • 2
    • 4
  • Elham Hooshmand
    • 5
  • Mohsen Jalilzadeh
    • 6
  • Amir Hossein Mahvi
    • 2
    • 7
  • Ali Akbar Mohammadi
    • 8
  1. 1.Students Research CommitteeNeyshabur University of Medical SciencesNeyshaburIran
  2. 2.Department of Environmental Health Engineering, School of Public HealthTehran University of Medical ScienceTehranIran
  3. 3.Department of Epidemiology and Biostatistics, School of Public HealthTehran University of MedicalTehranIran
  4. 4.Center for Air Pollution Research, Institute for Environmental Research (IER)Tehran University of Medical SciencesTehranIran
  5. 5.Neyshabur University of Medical ScienceNeyshaburIran
  6. 6.Department of EpidemiologyUrmia University of Medical SciencesUrmiaIran
  7. 7.Center for Solid Waste Research, Institute for Environmental ResearchTehran University of Medical SciencesTehranIran
  8. 8.Department of Environmental Health EngineeringNeyshabur University of Medical SciencesNeyshaburIran

Personalised recommendations