Background: Prehypertension is more likely to develop into hypertension in individuals with adiposity. We aimed to explore how adiposity influences prehypertension through gut microbiota. Methods: Kaplan–Meier and Cox proportional hazard regression models were employed to evaluate the association between prehypertension and adiposity in 649 individuals. Among them, 197 consented to provide fecal samples and were divided, along with 184 additional participants, into healthy controls (HC), individuals with adiposity and normal tension (Ad-NT), and those with prehypertension (Ad-pHT) based on body mass index (BMI) and blood pressure. Shotgun metagenomic sequencing was performed on fecal samples, followed by taxonomic and functional annotations using MetaPhlAn and HUMAnN. Linear discriminant analysis effect size (LEfSe) was used to analyze differences in microbial species and metabolic pathways across groups. Partial Spearman rank correlation analysis was used to assess microbial interactions, and the relationships among metabolic pathways, species, BMI, and blood pressure. Results: Elevated BMI independently predicted the risk of prehypertension (adjusted HR = 1.072, 95% CI: 1.002–1.147). We observed the depletion of Blautia wexlerae and Parabacteroides distasonis in populations with Ad-pHT. A multiclass logistic regression model distinguished individuals with Ad-pHT from HC and those with adiposity and normal tension (Ad-NT) (AUC = 0.704). Microbiota-microbiota interactions gradually become complex from HC to Ad-NT to Ad-pHT groups. Blautia wexlerae and Parabacteroides distasonis were associated with pathways involved in carbohydrate degradation (PWY-8004), fermentation (ANAEROFRUCAT-PWY), biosynthesis of secondary metabolites (PWY-6270), amino acid (ARGININE-SYN4-PWY), quinol and quinone (PWY-7992), and nucleoside and nucleotide (PWY-6700). Conclusion: Shifts in Blautia wexlerae and Parabacteroides distasonis , as well as their relationships with pathways (energy metabolism and amino acid biosynthesis), were observed in adiposity-related prehypertension. Blautia wexlerae and Parabacteroides distasonis might represent promising candidates for next-generation probiotics targeting weight management and blood pressure reduction, which require validation in clinical studies.

Current dietary patterns based on general consumption trends may not fully capture factors influencing arterial stiffness, a subclinical marker of cardiovascular disease (CVD). We aimed to identify data-driven dietary patterns and evaluate their associations with arterial stiffness in a population without known CVD. In this cross-sectional study of 1155 adults, food choices from a 16-item questionnaire were collected and brachial-ankle pulse wave velocity (baPWV) was measured as the arterial stiffness indicator. Multiple correspondence analysis followed by hierarchical clustering on principal components identified dietary patterns, and generalized linear models were used to assessed their associations with baPWV. Three dietary patterns were identified, mainly distinguished by whole grains, tubers, smoked foods, and salty foods. Compared with the Chinese-adapted Western diet (high smoked/salty foods intake), the Chinese-adapted Mediterranean diet (high whole grains/tubers intake, β = −0.30, 95% CI: −0.49 to −0.10) and conventional Chinese urban diet (low consumption of four key distinguishing components, β = −0.23, 95% CI: −0.40 to −0.07) were associated with lower baPWV. Despite complex dietary behaviors, simple food-choice data enabled identification of dietary patterns associated with arterial stiffness. However, given the cross-sectional design, these findings should be interpreted as exploratory associations rather than causal effects.