Waist circumference and fat intake are associated with high blood pressure in Mexican children aged 8 to 10 years

Association between PEMT rs7946 and blood pressure levels in Chinese adolescents

OBJECTIVES

This study was to explore blood pressure levels in Chinese adolescents with different genotypes of phosphatidylethanolamine N-methyltransferase (PEMT) gene ( PEMT ) rs7946, as well as effects of dietary intake on blood pressure levels with different genders and different genotypes of PEMT rs7946.

METHODS

PEMT rs7946 genotypes were identified by PCR-restriction fragment length polymorphism and verified by DNA sequencing. Blood pressure was measured using a standard mercury sphygmomanometer. Dietary intakes were analyzed based on a 3-day diet diary, and dietary components were calculated using computer software.

RESULTS

A total of 721 high school students (314 males and 407 females) at the age of 16.86 ± 0.59 years were included. The A allele carriers of PEMT rs7946 had increased levels of SBP, DBP, mean arterial pressure (MAP) and pulse pressure (PP) than the GG homozygotes in the female subjects. There were significant interactions between PEMT rs7946 and gender on SBP and MAP levels, regardless of whether an unadjusted or adjusted model was used. When dietary intake was taken into account, fat intake was positively associated with SBP and PP in the male GG homozygotes, while protein intake was positively associated with PP in the female A allele carriers of PEMT rs7946.

CONCLUSION

This study suggests that PEMT rs7946 is significantly associated with blood pressure levels in human being. There might be interactions among PEMT rs7946, gender, and dietary intake on blood pressure levels in the adolescent population.

Neck circumference: cutoff points for Brazilian children

ABSTRACT Objective The objective of the present study was to propose cutoff points of neck circumference for predicting overweight in Brazilian children. Methods We conducted a cross-sectional study with 875 children from public schools in Brazil. Weight, height, and neck circumference were measured. Nutritional status and the risk of complications were assessed based on the values of body mass index and neck circumference. Receiver operating characteristic curve analysis was used to verify the cutoff points. Results The median age was eight years, and the majority of the children had normal weights by body mass index and had no risk of metabolic complications by neck circumference. There was a correlation between neck circumference and body mass index (k=0.689; p<0.005). The mean values proposed for overweight were 29.2 cm for girls and 29.1 cm for boys. Conclusion Neck circumference had a good correlation with body mass index, and the cutoff points proposed can identify overweight in Brazilian children.

Association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents

Background

Determining high blood pressure in childhood is an important step to reduce the risk of occurrence of high blood pressure-related diseases in adulthood.

Aims

This study aimed to assess the association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents.

Patients and Methods

This cross-sectional study included 370 students (202 females, 168 males) aged 14 to 18 years from one private and one public school in Kayseri, Turkey. Some anthropometric measurements and 24-hour dietary recall of the students were obtained. Their blood pressures were measured, and the International Physical Activity Questionnaire and the Mediterranean Diet Quality Index (KIDMED) were used.

Results

The body mass index (BMI) mean and waist/height ratio of the hypertensive group were significantly higher than those of the prehypertensive group, whereas their daily potassium, calcium, and magnesium intakes were significantly lower than those of the normotensive group. The percentage of individuals with very low diet quality was higher in the hypertensive group than in the normotensive group (P > 0.05). The percentage of participants with sufficient physical activity was higher in the normotensive group than in the prehypertensive and hypertensive groups.

Conclusion

Factors such as high BMI and waist/height rates; low calcium, magnesium, and potassium intakes with diet; insufficient physical activity; and low quality of diet might cause an increase in the blood pressure.

Predictors of Childhood High Blood Pressure among Overweight and Obese Children and Adolescents according to the Lifestyle-Scoring Algorithm Using Data from Iranian Health Care Reform Plan

In this study, the association between dietary pattern and lifestyle in predicting hypertension (HTN) among 425 overweight and obese children and adolescents aged 6 to 18 years was evaluated. In the current cross-sectional study, the lifestyle-scoring algorithm was developed considering the Iranian Health Reform Plan (HRP) criterion. HTN was defined according to standard protocols. Hierarchical linear regression models were used for the analysis. The prevalence of overweight/obesity was 5.82%. The results showed that systolic and diastolic blood pressure (SBP, DBP) had significant positive correlation with age (p < 0.001 and p < 0.001) and body mass index (BMI) (p < 0.005 and p < 0.007), respectively. Moreover, DBP had a significant correlation with fruit consumption of less than 2 servings per day versus no consumption (p = 0.014, B = 0.444), fruit consumption of more than 2 servings per day versus no consumption (p = 0.014, B = 0.480), and vegetable consumption less than 3 servings per day versus no consumption (p = 0.045, B = −0.374). Moreover, DBP had a significant correlation with fast foods/junk foods consumption of 1–2 items per week versus almost daily consumption (p = 0.047, B = −0.177). The final model could predict 32.1% of HTN by SBP and DBP (R² = 0.32). According to our findings, lower intake of vegetables and fruits, higher amounts of fast foods, higher age and BMI could be potent predictors of high blood pressure among Iranian children and adolescents.

Fat Intake and Hypertension Among Adults in China: The Modifying Effects of Fruit and Vegetable Intake

INTRODUCTION

Evidence on the combined effect of fruit and vegetable intake and total fat intake on hypertension is scarce. This study aimed to explore the relationship among fruit and vegetable intake, fat intake, and hypertension risk among Chinese adults.

METHODS

Individuals who participated in the China Health and Nutrition Survey (2004, 2006, 2009, and 2011) and were free of hypertension at baseline (n=4,368) were categorized into quartiles (Q1, lowest; Q4, highest) according to their dietary fruit and vegetable intake and fat intake. Generalized estimation equation models, adjusted for confounders, were used to explore the relationship of fat intake with hypertension and systolic and diastolic blood pressure among all adults and within quartiles of fruit and vegetable intake. Data analyses were performed in 2018.

RESULTS

A total of 1,086 adults developed hypertension during follow-up. In the total population, the OR of the highest quartile of fat intake was 1.40 (95% CI=1.12, 1.75) compared with the lowest. Among individuals with low fruit and vegetable intake, the odds of hypertension for those in Q3 (OR=1.97, 95% CI=1.37, 2.83) and Q4 (OR=1.81, 95% CI=1.14, 2.90) of fat intake, compared with individuals in Q1, were even higher than for the overall sample. For each 50-gram increase in FI per day, the ORs of hypertension increased from fat intake Q1 to Q4 among all respondents and those with low fruit and vegetable intake, but not among those with high fruit and vegetable intake. Systolic blood pressure increased by 1.08 mm Hg (95% CI=0.03, 2.13) per 50-gram fat intake per day increment in the fruit and vegetable intake Q1 group, whereas the association was not significant in the fruit and vegetable intake Q2-Q4 groups.

CONCLUSIONS

Fruit and vegetable intake modifies the relationship between fat intake and hypertension, whereby high fruit and vegetable intake may offset the detrimental effect of fat intake on hypertension. Increased fruit and vegetable intake and controlled fat intake are recommended to prevent hypertension in Chinese adults.

Predictors for Blood Pressure Reduction in American Latinos: Secondary Analysis of the Adelgaza Program Data

Little is known about factors that predict blood pressure (BP) reduction in overweight American Latinos. The aim of this secondary analysis was to explore predictors of changes in mean systolic and diastolic BPs over an 8-week weight loss intervention period in a sample of 54 overweight American Latinos using data collected during the Adelgaza trial. Baseline BP, exercise energy use (in units of metabolic equivalent of task), weight change, average daily intake of calories from beverages, average daily intake of calories from fat, age, and gender were considered as potential predictors of reductions in BP, as measured at baseline, 3, and 8 weeks. Baseline characteristics were as follows: mean age 45.3 (SD = 10.8) years, 31.5% male, 61.1% born in the United States. Mean baseline systolic and diastolic BPs were 122.1 (SD = 14.4) mmHg and 76.6 (SD = 9.8) mmHg, respectively. Both baseline systolic and diastolic BPs predicted reductions in systolic BP after adjusting for other factors (p < .001). None of the nine variables predicted reductions in diastolic BP (p > .05). This finding suggests that overweight American Latinos with higher baseline systolic or diastolic BP should be identified and provided with early intervention education to achieve better hypertension management or prevention.

"It's Sort Of, Like, in My Family's Blood": Exploring Latino Pre-adolescent Children and Their Parents' Perceived Cultural Influences on Food Practices

This study examined the perceived connections between culture and food practices among Latino pre-adolescents (n = 17) and their parents (n = 15) through semi-structured interviews. Results show that pre-adolescents have formed perceptions concerning the association between their eating behaviors and cultural background that coincide with their parent's notions. Participants associated culture to both healthy and unhealthy food practices. Latin American food environments were described as healthier than in the US. The interviews revealed conflict between traditional foods preferences and perceptions of health, underscoring the need for better approaches to help Latino families navigate US food environments, while also preserving healthful traditional food practices.

Sodium intake and blood pressure in children and adolescents: a systematic review and meta-analysis of experimental and observational studies

Background

High sodium intake is a cause of elevated blood pressure in adults. In children and adolescents, less evidence is available and findings are equivocal. We systematically reviewed the evidence from experimental and observational studies on the association between sodium intake and blood pressure in children and adolescents.

Methods

A systematic search of the Medline, Embase, CINAHL and CENTRAL databases up to March 2017 was conducted and supplemented by a manual search of bibliographies and unpublished studies. Experimental and observational studies involving children or adolescents between 0 and 18 years of age were included. Random-effects meta-analyses were performed by pooling data across all studies, separately for experimental and observational studies, and restricting to studies with sodium intake and blood pressure measurement methods of high quality. Subgroup meta-analyses, sensitivity analyses and meta-regressions were conducted to investigate sources of heterogeneity and confounding. The dose-response relationship was also investigated.

Results

Of the 6572 publications identified, 85 studies (14 experimental; 71 observational, including 60 cross-sectional, 6 cohort and 5 case-control studies) with 58 531 participants were included. In experimental studies, sodium reduction interventions decreased systolic blood pressure by 0.6 mm Hg [95% confidence interval (CI): 0.5, 0.8] and diastolic blood pressure by 1.2 mm Hg (95% CI: 0.4, 1.9). The meta-analysis of 18 experimental and observational studies (including 3406 participants) with sodium intake and blood pressure measurement methods of high quality showed that, for every additional gram of sodium intake per day, systolic blood pressure increased by 0.8 mm Hg (95% CI: 0.4, 1.3) and diastolic blood pressure by 0.7 mm Hg (95% CI: 0.0, 1.4). The association was stronger among children with overweight and with low potassium intake. A quasi-linear relationship was found between sodium intake and blood pressure.

Conclusions

Sodium intake is positively associated with blood pressure in children and adolescents, with consistent findings in experimental and observational studies. Since blood pressure tracks across the life course, our findings support the reduction of sodium intake during childhood and adolescence to lower blood pressure and prevent the development of hypertension.

Waist circumference as high blood pressure predictor in school age children

Childhood hypertension is becoming more common with the increasing numbers of child obesity, which has encouraged new studies to identify a good anthropometric marker for high blood pressure levels. The objective this study was to identify the best anthropometric predictor of risk of hypertension in children between 8-10 years of age. The Children were evaluated for socioeconomic status and their blood pressure (BP), weight, height, waist circumference (WC) and percentage of body fat (PBF) were measured. The study included 445 children, of which 50.1% were females. The prevalence of obesity defined by body mass index (BMI) was 14.6%. Increased BP was found in 3.4% and 2.2% of the children, considering the pre-hypertension and hypertension classifications respectively. The arithmetic mean of BP value correlated significantly with BMI, WC and PBF. After height control, the correlations that were maintained significant were between WC and systolic blood pressure (SBP) and between WC and diastolic blood pressure (DBP). The variable with the highest predictive power of the occurrence of hypertension was WC. The results indicate that, in this population of children between 8 and 10 years old, WC is a measurement of higher value in predicting increased BP.

Correlates of elevated blood pressure in healthy children: a systematic review

The prevalence of hypertension in children is increasing globally. Addressing this will require a robust understanding of associated risk factors. To this end, we conducted a systematic review to identify correlates of elevated blood pressure (BP) in children. Literature searches were conducted using pre-defined search terms from three academic databases. The abstract and full text of identified studies were screened for eligibility by two independent reviewers. A total of 100 studies were included in this systematic review. An assessment tool was first used to assess study quality; a narrative synthesis was then performed. We found a broad range of physiological, social and behavioural factors associated with elevated BP in children. The most common correlate observed was adiposity, suggesting that childhood obesity may be implicated in the increased prevalence of hypertension observed in children. However, the broad range of other factors identified underscores the multi-factorial aetiology of hypertension. Data from a broad range of studies showed that the correlates of hypertension in children are multi-factorial. Therefore, approaches aimed at preventing hypertension must in turn be multi-factorial to ensure that the burden of hypertension in childhood is addressed.

Association of Anthropometric Indices of Obesity with Hypertension in Chinese Elderly: An Analysis of Age and Gender Differences

This study aims to explore the association of anthropometric indices of obesity with hypertension in Chinese elderly and its possible gender and age differences. A total of 7070 adults age 60 or older were interviewed in a cross-sectional study conducted in 2017. Anthropometric indices for each participant were measured by using standard methods of trained doctoral/master students. We performed two binary logistic regression models to examine the association of the nine different anthropometric indices and hypertension by gender. Lastly, analyses were performed in two steps stratified for age. Comparing individuals with and without hypertension, there were statistically significant differences in anthropometric indices except height, a body shape index (ABSI), and hip index (HI) in males; and except height in females. There were gender differences in the relationship between anthropometric indices and the prevalence of hypertension in Chinese older adults. After stratification by age, the associations of all anthropometric indices became weaker, disappeared, or even went in the opposite direction. Furthermore, body mass index (BMI) in men (except individuals older than 80) and hip circumference (HC) in women showed a significant impact on the risk of hypertension. The association of anthropometric indices of obesity with hypertension in Chinese elderly differ by gender and age. These findings indicate a need to develop gender-specific strategies for the male and female elderly in the primary and secondary prevention of hypertension.

Influence of waist circumference on blood pressure status in non-obese adolescents

Objectives To check whether excess in abdominal adiposity and metabolic factors were associated with blood pressure abnormalities in non-obese adolescents. Methods We randomly selected 1100 adolescent students, aged 12-18 years, from schools and classrooms in the city of Constantine, Algeria. Among them 179 were overweight and 51 were obese (IOTF criteria). Waist circumference (WC) was considered high if >74 cm in boys and 75 cm in girls (mean of WC of all population studied). Hypertension (HBP) and prehypertension (preHBP) were defined by the NHBPEP's 2004 criteria. Results The prevalence of HBP/preHBP were 13.0%/12.4% with no difference between boys and girls. The percentages of HBP/preHBP patients were 15.6%/15.6% in overweight adolescents, 5.9%/31.4% in obese adolescents and 12.9%/10.6% in adolescents with normal body weight (p < 0.0001). In obese adolescents, the prevalence of HBP was higher among boys than girls (36% vs. 27%, p = 0.002). In normal and overweight adolescents, the prevalence of HBP and preHBP was similar in boys and girls (11.9% vs. 11.0% and 14.7% vs. 12.1%); the association of WC (high vs. not high) with HBP was found in boys (16.1% vs. 8.8%, p = 0.009) but not in girls (12.1% vs. 10.2%), and with preHBP in girls (15.5% vs. 8.0%, p = 0.029) but not in boys (16.2% vs. 13.6%). Waist circumference [OR: 1.04 (1.03-1.06); p < 0.0001] and HOMA index [OR: 1.65 (1.13-2.39); p = 0.009] were associated with an increased risk of HBP. Conclusion In non-obese adolescents, a high WC, defined by values over the mean WC observed in our population, is associated with a higher risk of HBP in boys.

Waist Circumference is Associated with Blood Pressure in Children with Normal Body Mass Index: A Cross-Sectional Analysis of 3,417 School Children

Background

The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children.

Objective

Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges.

Methods

Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant.

Results

Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17).

Conclusion

In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.

Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy. These guidelines include 30 Key Action Statements and 27 additional recommendations derived from a comprehensive review of almost 15 000 published articles between January 2004 and July 2016. Each Key Action Statement includes level of evidence, benefit-harm relationship, and strength of recommendation. This clinical practice guideline, endorsed by the American Heart Association, is intended to foster a patient- and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient diagnoses and outcomes, support implementation, and provide direction for future research.

Role of Obesity Variables in Detecting Hypertension in an Iranian Population

INTRODUCTION

As the high incidence of hypertension has been in conjunction with dramatic increase in the prevalence of obesity, many studies have suggested obesity as its underlying cause in diverse race and ethnic groups.

AIM

The present study was designed to quantify the relationship between obesity variables and hypertension in Iranian population. A ROC curve analysis was also used to determine an optimal BMI cutoff for obesity with the aim of representing elevated incidence of hypertension in this population.

METHODS

The study population comprised of apparently healthy men and women who participated in the Iranian Multi-centric Osteoporosis Studies (IMOS), a multi-centric cross-sectional study carried out in urban areas of five great cities (Tehran, Tabriz, Mashhad, Shiraz and Bushehr). The anthropometric (weight, height, waist and hip circumferences) and blood pressure measures were reported in some 5724 subjects. The influence of these factors on systolic and diastolic blood pressure was assessed based on a list-wise method.

RESULTS

There was a significant difference in the studied subjects anthropometric (weight classes (BMI), WC and HC, and WHR) and blood pressure variables; age, gender and weight, however, were the only factors significantly influencing SBP and DBP. Furthermore, BMI showed a significant impact on the overall risk of developing hypertension.

CONCLUSION

General obesity rather than abdominal obesity is directly linked with higher blood pressure levels in Iranian population.

Dietary intake and prospective changes in cardiometabolic risk factors in children and youth

Only few studies examined the effect of diet on prospective changes in cardiometabolic (CM) risk factors in children and youth despite its importance for understanding the role of diet early in life for cardiovascular disease in adulthood. To test the hypothesis that dietary intake is associated with prospective changes in CM risk factors, we analyzed longitudinal observations made over a period of 2 years among 448 students (aged 10-17 years) from 14 schools in Canada. We applied mixed effect regression to examine the associations of dietary intake at baseline with changes in body mass index, waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), and insulin sensitivity score between baseline and follow-up while adjusting for age, sex, and physical activity. Dietary fat at baseline was associated with increases in SBP and DBP z scores (per 10 g increase in dietary fat per day: β = 0.03; p < 0.05) and WC (β = 0.31 cm; p < 0.05) between baseline and follow-up. Every additional gram of sodium intake at baseline was associated with an increase in DBP z score of 0.04 (p < 0.05) between baseline and follow-up. Intake of sugar, vegetables and fruit, and fibre were not associated with changes in CM risk factors in a statistically significant manner. Our findings suggest that a reduction in the consumption of total dietary fat and sodium may contribute to the prevention of excess body weight and hypertension in children and youth, and their cardiometabolic sequelae later in life.

The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.

Effects of protein intake on blood pressure, insulin sensitivity and blood lipids in children: a systematic review

High protein intake in early childhood is associated with obesity, suggesting possible adverse effects on other cardiometabolic outcomes. However, studies in adults have suggested beneficial effects of protein intake on blood pressure (BP) and lipid profile. Whether dietary protein intake is associated with cardiovascular and metabolic health in children is unclear. Therefore, we aimed to systematically review the evidence on the associations of protein intake with BP, insulin sensitivity and blood lipids in children. We searched the databases Medline, Embase, Cochrane Central and PubMed for interventional and observational studies in healthy children up to the age of 18 years, in which associations of total, animal and/or vegetable protein intake with one or more of the following outcomes were reported: BP; measures of insulin sensitivity; cholesterol levels; or TAG levels. In the search, we identified 6636 abstracts, of which fifty-six studies met all selection criteria. In general, the quality of the included studies was low. Most studies were cross-sectional, and many did not control for potential confounders. No overall associations were observed between protein intake and insulin sensitivity or blood lipids. A few studies suggested an inverse association between dietary protein intake and BP, but evidence was inconclusive. Only four studies examined the effects of vegetable or animal protein intake, but with inconsistent results. In conclusion, the literature, to date provides insufficient evidence for effects of protein intake on BP, insulin sensitivity or blood lipids in children. Future studies could be improved by adequately adjusting for key confounders such as energy intake and obesity.

Effects of supervised exercise program on metabolic function in overweight adolescents

BACKGROUND

Inactivity is a primary factor related to childhood obesity, yet aerobic exercise has been shown to prevent weight gain and improve fitness in adolescents. Moreover, children become less active during their summer break from school. This study compared the effects of 4 and 8 weeks of supervised summer activity versus an unsupervised summer break on metabolic function and fitness in adolescents.

METHODS

Twenty-two adolescents were divided into 4-week (n=6, weight 48.1±14.9 kg, body fat 27.4±8.4%) and 8-week exercise groups (n=6, weight 43.4±10.9 kg, body fat 28.5±12.8%), that performed supervised, play-based physical activity, versus an age-matched 8 week control group that maintained their typical summer break (n=10, weight 41.7±10.0 kg, body fat 23.7±8.0%). Anthropometrics, resting energy expenditure (REE), resting heart rate (RHR) and peak aerobic capacity (VO(2peak)) were evaluated before and after the intervention (4 or 8 weeks).

RESULTS

REE showed group differences in posttraining conditions (the 4-week group vs. the control group, 1220±169 vs. 1067±144 kcal/die, and the 8-week group vs. the control group, 1202±151 vs. 1067±144 kcal/die, P=0.047), but RHR decreased (pre-program vs. post program: 97±22 vs. 80±8 beat/min, P=0.001) and VO(2peak) significantly increased (pre-program vs. post program: 27.8±7.8 vs. 34.8±6.5 mL/kg/min, P=0.001) in the 8-week group compared to the control group.

CONCLUSIONS

Eight weeks of supervised play-based activity increased REE and VO(2peak) in adolescents with concomitant decreases in RHR. These data suggest that this novel model of exercise prescription could be considered world-wide by clinicians to improve fitness base in adolescents and help to combat the growing epidemic of childhood obesity.

Risk factors for high blood pressure in low income children aged 3-4 years

This study aimed to evaluate the effect of dietary sodium intake on blood pressure among low income children aged 3-4 years. Data were collected during a randomized trial conducted in São Leopoldo, Brazil, with 500 mother-child pairs recruited from the maternity ward of a local hospital. Breastfeeding data were obtained during the children's first year of life. At 3 to 4 years of age, children's anthropometric, dietary, and blood pressure assessments were obtained. Sodium intake was estimated from two multiple-pass 24-h dietary recalls. Systolic blood pressure > 90th percentile for age, sex, and height was classified as high systolic blood pressure, according to the population-based percentiles provided by the Task Force on Hypertension Control in Children and Adolescents. Blood pressure data were obtained from 331 children at 3 to 4 years. The mean value of systolic blood pressure was 91.31 mmHg (SD = 8.30 mmHg) and 5.2% (n = 17) presented high systolic blood pressure. The results of the multivariable analyses showed that children who consumed more than 1,200 mg of sodium/day and with waist-to-height ratio higher than 0.5 presented, respectively, 3.32 (95%CI 0.98-11.22) and 8.81 (95%CI 2.13-36.31) greater risk of having high systolic blood pressure. Exclusive breastfeeding, child overweight and change in body mass index z score during the first year of life were not associated with the outcome.

CONCLUSIONS

The results of this study suggest that at preschool age sodium intake and high waist-to-height ratio are risk factors for high systolic blood pressure.

Nutritional quality of foods and beverages on child-care centre menus in Mexico

OBJECTIVE

The purpose of the present study was to assess the nutritional quality of foods and beverages listed on menus serving children in government-sponsored child-care centres throughout Mexico.

DESIGN

For this cross-sectional menu assessment, we compared (i) food groups and portion sizes of foods and beverages on the menus with MyPlate recommendations and (ii) macronutrients, sugar and fibre with Daily Reference Intake standards.

SETTING

Menus reflected foods and beverages served to children attending one of 142 government-sponsored child-care centres throughout Mexico.

SUBJECTS

There were fifty-four distinct menus for children aged 4–6 months, 7–9 months, 10–12 months, 13–23 months, 24–47 months and 48–72 months.

RESULTS

Menus included a variety of foods meeting minimum MyPlate recommendations for each food category except whole grains for children aged 48–72 months. Menus listed excessive amounts of high-energy beverages, including full-fat milk, fruit juice and sugar-sweetened beverages for children of all ages. The mean daily energy content of menu items yielded an average of 2?76 MJ for infants, 4.77 MJ for children aged 13–23 months, 5.36 MJ for children aged 24–47 months and 5.87 MJ for children aged 48–72 months. Foods and beverages on menus provided sufficient grams of carbohydrate and fat, but excessive protein.

CONCLUSIONS

Menus provided a variety of foods but excessive energy. Whole grains were limited, and high-energy beverages were prevalent. Both may be appropriate targets for nutrition intervention. Future studies should move beyond menus and assess what children actually consume in child care.

Fetal programming of the neuroendocrine-immune system and metabolic disease

Adverse uterine environments experienced during fetal development can alter the projected growth pattern of various organs and systems of the body, leaving the offspring at an increased risk of metabolic disease. The thrifty phenotype hypothesis has been demonstrated as an alteration to the growth trajectory to improve the survival and reproductive fitness of the individual. However, when the intrauterine environment does not match the extrauterine environment problems can arise. With the increase in metabolic diseases in both Westernized and developing countries, it is becoming apparent that there is an environmental disconnect with the extrauterine environment. Therefore, the focus of this paper will be to explore the effects of maternal malnutrition on the offspring's susceptibility to metabolic disorders such as obesity, cardiovascular disease, and diabetes with emphasis on programming of the neuroendocrine-immune system.

Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia

Background

In southern and eastern Mediterranean countries, changes in lifestyle and the increasing prevalence of excess weight in childhood are risk factors for high blood pressure (BP) during adolescence and adulthood. The aim of this study was to evaluate the BP status of Tunisian adolescents and to identify associated factors.

Methods

A cross-sectional study in 2005, based on a national, stratified, random cluster sample of 1294 boys and 1576 girls aged 15-19 surveyed in home visits. The socio-economic and behavioral characteristics of the adolescents were recorded. Overweight/obesity were assessed by Body Mass Index (BMI) from measured height and weight (WHO, 2007), abdominal obesity by waist circumference (WC). BP was measured twice during the same visit. Elevated BP was systolic (SBP) or diastolic blood pressure (DBP) ≥ 90th of the international reference or ≥ 120/80 mm Hg for 15-17 y., and SBP/DBP ≥ 120/80 mm Hg for 18-19 y.; hypertension was SBP/DBP ≥ 95th for 15-17 y. and ≥ 140/90 mm Hg for 18-19 y. Adjusted associations were assessed by logistic regression.

Results

The prevalence of elevated BP was 35.1%[32.9-37.4]: higher among boys (46.1% vs. 33.3%; P < 0.0001); 4.7%[3.8-5.9] of adolescents had hypertension. Associations adjusted for all covariates showed independent relationships with BMI and WC: - obesity vs. no excess weight increased elevated BP (boys OR = 2.1[1.0-4.2], girls OR = 2.3[1.3-3.9]) and hypertension (boys OR = 3.5[1.4-8.9], girls OR = 5.4[2.2-13.4]), - abdominal obesity (WC) was also associated with elevated BP in both genders (for boys: 2nd vs. 1st tertile OR = 1.7[1.3-2.3], 3rd vs.1st tertile OR = 2.8[1.9-4.2]; for girls: 2nd vs. 1st tertile OR = 1.6[1.2-2.1], 3rd vs.1st tertile OR = 2.1[1.5-3.0]) but only among boys for hypertension. Associations with other covariates were weaker: for boys, hypertension increased somewhat with sedentary lifestyle, while elevated BP was slightly more prevalent among urban girls and those not attending school.

Conclusion

Within the limits of BP measurement on one visit only, these results suggest that Tunisian adolescents of both genders are likely not spared from early elevated BP. Though further assessment is likely needed, the strong association with overweight/obesity observed suggests that interventions aimed at changing lifestyles to reduce this main risk factor may also be appropriate for the prevention of elevated BP.

Pressão arterial elevada e obesidade abdominal em adolescentes

OBJETIVO: Analisar a associação entre obesidade abdominal e pressão arterial elevada em adolescentes da rede pública de ensino da região metropolitana da cidade de Londrina (PR). MÉTODOS: Constituiu-se uma amostra de 656 adolescentes com idades entre dez e 13 anos. Foram realizadas análises antropométricas de massa corporal, estatura e circunferência de cintura, além da aferição da pressão arterial de repouso. Para análise e comparação dos dados, foram aplicados Mann-Whitney e o teste t de Student. Também foram analisadas as possíveis associações entre pressão arterial e circunferência de cintura por meio do teste do qui-quadrado. RESULTADOS: Foram identificadas associações entre obesidade abdominal e pressão arterial elevada em ambos os sexos (RP 2,7; IC95% 1,8-4,2). Além disso, verificou-se que, independentemente do grupo etário, a obesidade abdominal associa-se com valores mais elevados de pressão arterial. CONCLUSÕES: A obesidade abdominal está associada à ocorrência de aumento da pressão arterial em adolescentes.

Body mass index and waist circumference are associated with blood pressure in preschool-aged children

PURPOSE

Population-derived data on the association between body mass index (BMI) and blood pressure (BP) during early childhood are lacking. We investigated the association between BMI, waist circumference, and BP among preschool-aged children.

METHODS

A total of 1294 children ages 3 to 6 years were examined in the Sydney Paediatric Eye Disease Study during 2007 to 2009. Height, weight, and waist circumference were collected and BMI calculated. The weight status of each child was classified on the basis of age- and sex-specific BMI percentiles. BP was measured by the use of a standard protocol.

RESULTS

A prevalence of 11.0% and 15.1% of children were obese or overweight, respectively. The prevalence of elevated BP was 21.3% among obese children compared with 12.4% of nonoverweight/obese children (p = .03). An increase of 1 BMI unit was independently associated with, on average, a 0.57 and 0.56 mm Hg increase in systolic and diastolic BP, respectively. Each unit increase in waist circumference was associated with a 0.14 and 0.23 mm Hg increase in systolic and diastolic BP, respectively.

CONCLUSIONS

A strong and independent association between adiposity and BP was present during early childhood. These data have important public health implications because elevated BP at a young age may be associated with increased cardiovascular risk in later life.

Waist circumference and risk of elevated blood pressure in children: a cross-sectional study

Background

Increasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildren's waist circumference (WC) and risk of elevated blood pressure.

Methods

We measured height, weight, neck and waist circumference, and blood pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated blood pressure was defined in children found to have mean systolic or diastolic blood pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile blood pressure value.

Results

All 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic blood pressure increased as WC quartiles increased (p < 0.0001). The prevalence of elevated blood pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of elevated blood pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with elevated blood pressure were 1.14 (95% CI = 1.10-1.18) and 2.22 (95% CI = 1.76-2.78), respectively.

Conclusions

Elevated blood pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than blood pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and blood pressure risks.

Adjusting adiposity and body weight measurements for height alters the relationship with blood pressure in children

BACKGROUND

Adiposity measures are associated with increased pediatric blood pressure (BP). However, this correlation can be confounded by the relationship of both variables to height. We evaluated whether adiposity and anthropometric measures were associated with pediatric BP before and after adjusting each value for height.

METHODS

Participants included 281 African-American (AA), European-American (EA), and Hispanic-American (HA) children aged 7-12 years. BP percentiles were calculated according to pediatric guidelines using the average of four measurements. Total fat mass was determined using dual-energy X-ray absorptiometry. Socioeconomic status (SES) was calculated with the Hollingshead index. Adiposity measures were indexed for height using log-log regression analysis. Partial correlations identified measures associated with BP. Linear regression was used to test the association of those measures with absolute BP, whereas logistic regression was used to evaluate the odds for hypertension.

RESULTS

More AAs (16.3%) presented with potential hypertension than EA (5.1%) or HA (2.7%) children. After adjusting for covariates, fat mass, body mass index, and waist circumference were positively significantly associated with absolute BP and hypertension in AA and EA children (P < 0.05). When these measures were height-indexed, only waist remained significantly positively associated with hypertension risk in these two groups. No measures were significantly associated with BP among HA children.

CONCLUSIONS

In this multiethnic pediatric population, waist circumference was the strongest significant adiposity predictor of hypertension risk among AA and EA children. Additional research is needed to determine which environmental and genetic factors contribute to pediatric hypertension, particularly among HA groups.