The relationship of waist circumference distribution to blood pressure levels among children and adolescents in Shandong, China

Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang, China

General and central obesity are suggested to be associated with elevated blood pressure (BP), whereas few studies have investigated their combined associations with hypertension in children. This study aimed to assess the associations of combinations of general obesity and central obesity with hypertension in Chinese children, including its stages and phenotypes. A total of 5430 children aged 7-17 years in Zhejiang Province were enrolled. General obesity was evaluated by body mass index (BMI), while central obesity was by waist circumference (WC). Then all children were sorted into three mutually exclusive groups: normal weight with or with no central obesity (NW), abnormal weight with no central obesity (AWNCO), and abnormal weight with central obesity (AWCO). Hypertension was defined as either a systolic or diastolic BP ≥ 95th percentile, and further classified into stage 1 hypertension, stage 2 hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH). Logistic regression was used. AWNCO and AWCO were associated with stage 1 hypertension (AWNCO, odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.59-2.37; AWCO, 2.67, 2.20-3.25), stage 2 hypertension (AWNCO, 2.35, 1.33-4.13; AWCO, 4.53, 2.79-7.37), ISH (AWNCO, 2.50, 1.96-3.18; AWCO, 3.95, 3.15-4.95), and SDH (AWNCO, 2.48, 1.75-3.52; AWCO, 2.78, 1.94-3.99). Children with AWCO were more likely to have stage 1 and stage 2 hypertension, as well as ISH and SDH. The combined measurement of general and central obesity is suggested as an appropriate screening tool for hypertension among children and adolescents.

Effect of changes in body mass index and waist-to-height ratio on blood pressure in 11- to 13-year-old children: a prospective population study

BACKGROUND

Existing evidence about associations between change in body mass index (BMI) and waist-to-height ratio (WHtR) change and high blood pressure are relatively limited.

AIMS

We aimed to investigate the associations of general overweight (based on BMI) and abdominal obesity (based on WHtR) change with high blood pressure in Chinese children.

SUBJECTS AND METHODS

A school-based cohort study in Ningbo region (China) was conducted among children with baseline evaluations in October 2016 with follow-up two years later. A total of 1432 children aged 11-13 years participated in this study.

RESULTS

Our results showed that a change from normal BMI or WHtR to overweight or abdominal obesity in children was associated with high blood pressure (adjusted odds ratio (AOR), 2.62; p<0.05 or AOR, 2.79; p<0.05, respectively). In addition, an increased risk of high blood pressure was observed in children who maintained overweight or abdominal obesity (AOR, 1.67; p<0.05 or AOR, 1.69; p<0.05, respectively), but not in children who experienced remission to non-excess weight. Interestingly, children who increased BMI or WHtR had greater impact on SBP than on DBP.

CONCLUSION

The 2-year longitudinal study indicated that general overweight or abdominal obesity can predict the risk factor of high blood pressure in children. However, children who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range.

Association of general and central adiposity with blood pressure among Chinese adults: results from the China National Stroke Prevention Project

BACKGROUND

The American Heart Association concluded that waist circumference was a better predictor of blood pressure risk than BMI in Asians. However, data are inconsistent and information in Chinese, the largest global population group, is limited.

METHODS

Data was obtained from the Chinese National Stroke Prevention Project Survey of a nationally representative sample of middle-aged and older Chinese adults. A total of 135 825 individuals not taking any antihypertensive drugs were included in this study. Multiple linear regression analyses were conducted to examine the association between blood pressure and parameters of general adiposity, including BMI, height-adjusted weight, and parameters of central adiposity, including waist circumference, hip circumference, waist-hip ratio, and waist-height ratio. Results were shown as mean difference in blood pressure associated with one standard deviation higher level of adiposity.

RESULTS

The overall means ± standard deviation of BMI and waist circumference were 24.3 ± 3.18 kg/m and 84.0 ± 8.88 cm, respectively. BMI seemed more strongly associated with SBP/DBP (4.22 mmHg/SD; 2.60 mmHg/SD) than central adiposity markers. In addition, there were sex differences. For men, waist circumference showed a stronger association with SBP/DBP than BMI (4.04 vs. 3.79, P < 0.05; 2.26 vs. 2.13, P < 0.05). For women, BMI was more closely related to SBP/DBP than central adiposity parameters, such as waist circumference (4.59 vs. 3.41, P < 0.05; 2.98 vs. 2.24, P < 0.05). Additionally, in both urban and rural areas, waist circumference was mostly associated with SBP/DBP among men, whereas it was BMI among women.

CONCLUSION

Compared with central adiposity, blood pressure is more strongly associated with general adiposity in Chinese adults. Interestingly, there are significant sex differences in the relationship of blood pressure with general and central adiposity. Waist circumference is the strongest predictor for men but suboptimal for women, and BMI tend to a better predictor of blood pressure for women. In addition, our results for men are consistent with the recommendation of the American Heart Association in 2015 that waist circumference could be used for assessing the risk of blood pressure.

Association between hypertension and adiposity indicators: A study among the Muslim population of Uttar Pradesh

BACKGROUND

Hypertension and obesity have become a global issue and an important public health concern due to an unhealthy lifestyle. The present study aims to determine the prevalence of hypertension and its association with various adiposity indicators among Sunni Muslim population of Lucknow, Uttar Pradesh.

MATERIALS AND METHODS

A cross-sectional study was conducted among 214 individuals using purposive sampling method. Somatometric measurements were taken using the ISAK protocol. Correlation analysis and odds ratio were calculated to determine the best predictor of hypertension.

RESULTS

41% of males and 42.1% of females were found to be in Stage-II hypertension. BMI and WC were found to have the highest correlation with SBP among males and females, respectively. WHR followed by WC and BMI, was found to be the strongest predictor of hypertension in males. In the case of females, WHtR Followed by, BMI and WHR were found to be the strongest predictors of hypertension.

CONCLUSION

Among the presently studied Muslim population of Lucknow, a high prevalence of hypertension was found among both males and females. Also, WHR among males and WC among females were found to be better predictors of hypertension. Thus, for better prediction of risk of hypertension, sex and ethnicity-specific adiposity indicator should be used in clinical practice.

Intensified association between waist circumference and hypertension in abdominally overweight children

BACKGROUND

Abdominal adiposity is an important risk factor for childhood hypertension. The present study aimed to compare the strength of the association between waist circumference (WC) and hypertension in children with different WC levels.

METHODS

A total of 82,413 Chinese children aged 9-17 years were selected. An abdominally overweight child was defined as a child with WC ≥75th sex- and age-specific percentile. Hypertension was categorised as ≥95th sex-, age- and height-specific percentile. Logistic regression model was applied to calculate the odds ratio (OR) and 95% confidence interval (CI) of WC for hypertension after WC was transformed into sex- and age-specific z-score.

RESULTS

Abdominally overweight children presented a higher risk of hypertension (OR: 2.39; 95% CI: 2.26, 2.54) than children with normal WC. In children with normal WC, one sex- and age-specific standard deviation increase in WC was associated with a 42% increase in odds of hypertension (OR: 1.42; 95% CI: 1.30, 1.55). That increase was elevated to 74% in abdominally overweight children (OR: 1.74; 95% CI: 1.66, 1.82). A similar pattern was also observed in different sex and area groups, and in children 9-14 years old.

CONCLUSIONS

An intensified association between WC and hypertension was observed in abdominally overweight Chinese children. The gain in WC was associated with greater increase in hypertensive risk in abdominally overweight children than that of children with normal WC. These findings could improve intervention strategies for hypertension risk reduction in children.

Self-management training for Chinese obese children at risk for metabolic syndrome: Effectiveness and implications for school health

This article reviews the results of a school-based self-management intervention for Chinese obese children at risk for metabolic syndrome. Twenty-eight Chinese obese children ( M age = 10 years) and their parents participated in the study. Metabolic syndrome risk factors were measured pre- and post-intervention. The risk factors included Body Mass Index, waist circumstance, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, High-sensitivity C-reactive Protein, fasting plasma glucose, and fasting blood insulin. After 6 months of school-based self-management intervention, all risk factors with the exception of triglycerides and fasting plasma glucose changed significantly in the healthful direction ( p < 0.01). This pilot study offers promising implications for school interventions that are delivered by school-based practitioners collaborating with parents, teachers, and children. An individualized program based on a self-care and -management framework may have utility as a relatively cost-effective, school-based intervention to improve children’s health.

Metabolic syndrome among children and adolescents from Southern Italy: contribution from the Calabrian Sierras Community Study (CSCS)

Among 1657 children and adolescents aged 6 to 14 years (787, 47% girls and 870, 53% boys) from primary and secondary schools in a 14-town Southern Italian community, HDL cholesterol (54 ± 15 mg/dl), triglycerides (61 ± 29 mg/dl), blood glucose (78 ± 10 mg/dl), systolic (101 ± 11 mm Hg) and diastolic (62 ± 10 mm Hg) blood pressures, waist circumference (WC) (66 ± 10 cm) and WC/height (0.46 ± 0.006) and triglycerides/HDL cholesterol (1.31 ± 0.99) ratios were measured. The distributions were similar in both genders. Age did not affect triglycerides/HDL cholesterol ratio, whereas there was a slightly positive correlation (p<0.00001) between WC/height and triglycerides/HDL cholesterol ratios. We present individual gender and age specific percentile distributions (as Supplementary materials). Using percentile cut-offs (≤ 10th for HDL cholesterol and ≥ 90th for the other components), there were 183 (11%) children or adolescents with low HDL cholesterol, 162 (9.77%) with high triglycerides, 178 (10.74%) with high blood glucose, 178 (10.74%) with high WC, 244 (20.76%) with high systolic or diastolic BP and 126 (7.6%) with high systolic and diastolic BP. Abnormally high BP was seen in 470 (28.36%) children or adolescents. Using abnormal percentile values of 3 of 5 of its components, metabolic syndrome (MS) was diagnosed in 70 (4.2%) subjects, similarly in both genders. To assess out-of-limit distributions of all 5 individual MS components in children and adolescents gender- and age-distributions derived from local epidemiological data should be used: these distributions are presented and they might now be used both for comparative and applicative purposes at least in Southern Europe.

Percentiles of waist-hip ratio and the relationship with blood pressure among children and adolescents in Shandong, China

BACKGROUND

Anthropometric indices such as waist circumference (WC), waist-to-height ratio (WHtR) and waist-hip ratio (WHR) have been recognized as useful alternatives to visceral fat measurement in epidemiological studies. WHR has been used extensively in adults. However, there are very few published data for WHR among children and adolescents.

AIM

The present study examined the distribution of WHR and the relationship with blood pressure (BP) among children and adolescents in Shandong, PR China.

SUBJECTS AND METHODS

Data for this study were obtained from a large cross-sectional survey of schoolchildren carried out in 2010. A total of 38,822 students (19,456 boys and 19,366 girls) aged 7-17 years participated in this study. WC, Hip circumference (HC), systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were measured; WHR was calculated as WC divided by HC. Abdominal obesity was defined by previously published WHR references based on Chinese children and adolescents living in Beijing. All subjects were divided into two groups (group 1 with WHR <85th; group 2 with WHR ≥85th) according to the percentiles of WHR and comparisons of the SBP and DBP between the two groups were made.

RESULTS

The WHR levels in Shandong boys and girls were lower than those from German and Pakistani. The overall prevalence of abdominal obesity was 9.53% (95% CI = 9.12-9.95%) for boys and 9.82% (95% CI = 9.40-10.24%) for girls, no statistical differences between the two genders were observed (p > 0.05). In both boys and girls, the Z-scores of SBP and DBP were all significantly lower in group 1 than in group 2 (p < 0.01), indicating that children and adolescents with high WHR tended to have higher BP values.

CONCLUSION

WHR is useful in identifying children and adolescents at risk of developing high BP. These findings, together with the known tracking of BP from adolescence into adulthood, highlight the importance of preventing overweight and obesity among children and adolescents in order to prevent the development of hypertension in adults.

High blood pressure and its association with body weight among children and adolescents in the United Arab Emirates

Objectives

To estimate the prevalence of high blood pressure (BP) and its relationship with obesity among children and adolescents.

Methodology/Principal Findings

In this cross-sectional population (Emirati) representative study, we invited a random sample of 1600 students (grades 1–12) attending 23 out of all 246 schools in the Emirate of Abu Dhabi, United Arab Emirates. But analysis was restricted to Emirati nationals aged 6–17 years. We measured BP, height, weight, waist circumferences (WC), and calculated body mass index (BMI) by standard methods. BP levels ≥90^th percentile but <95^th percentile and ≥ 95^th for age, sex, and height (CDC percentiles) were classified as pre-hypertension (pre-HTN) and hypertension (HTN), respectively. Associations between BP, age, BMI, WC, and sex, were investigated by (multiple) linear regression methods. A total of 999 (47% girls) students provided complete results. The prevalence of pre-HTN was 10.5% and 11.4% and the prevalence of HTN was 15.4% and 17.8% among boys and girls, respectively. The prevalence of systolic/diastolic HTN was 14.4%/2.5% and 14.8/7.4% among boys and girls, respectively. BMI CDC percentile was positively correlated with WC percentile (r = 0.734, p<0.01), and both systolic (r = 0.34, p<0.001) and diastolic (r = 0.21, p<0.001) standardized BP. WC percentile was less strongly correlated with standardized SBP (r = 0.255, p<0.01) and DBP (r = 0.175, p<0.01) than BMI.

Conclusions/Significance

The prevalence of elevated BP, notably systolic was significantly high among the Emirati children and adolescents in Abu Dhabi. High BP was strongly related to body weight, and appears more strongly associated with BMI than WC. Further studies are required to investigate the impact of childhood obesity on HTN.