Blood pressure and BMI in adolescents in Aracaju, Brazil

Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya

OBJECTIVE

We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status.

METHODS

Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity.

RESULTS

About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption.

CONCLUSION

These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis

OBJECTIVE

To estimate the burden of excess weight in Brazilian adolescents.

DESIGN

Systematic review with meta-analysis.

SETTING

We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI.

PARTICIPANTS

Brazilian adolescents (10 to 19 years old).

RESULTS

One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000.

CONCLUSIONS

The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

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.

What Physical Fitness Component Is Most Closely Associated With Adolescents' Blood Pressure?

This study aimed to determine which of four selected physical fitness variables, would be most associated with blood pressure changes (systolic and diastolic) in a large sample of adolescents. This was a descriptive and cross-sectional, epidemiological study of 1,117 adolescents aged 14-19 years from southern Brazil. Systolic and diastolic blood pressure were measured by a digital pressure device, and the selected physical fitness variables were body composition (body mass index), flexibility (sit-and-reach test), muscle strength/resistance (manual dynamometer), and aerobic fitness (Modified Canadian Aerobic Fitness Test). Simple and multiple linear regression analyses revealed that aerobic fitness and muscle strength/resistance best explained variations in systolic blood pressure for boys (17.3% and 7.4% of variance) and girls (7.4% of variance). Aerobic fitness, body composition, and muscle strength/resistance are all important indicators of blood pressure control, but aerobic fitness was a stronger predictor of systolic blood pressure in boys and of diastolic blood pressure in both sexes.

Prevalence of hypertension among adolescents: systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of hypertension among adolescent Brazilian students.

METHODS

A systematic review of school-based cross-sectional studies was conducted. The articles were searched in the databases MEDLINE, Embase, Scopus, LILACS, SciELO, Web of Science, CAPES thesis database and Trip Database. In addition, we examined the lists of references of relevant studies to identify potentially eligible articles. No restrictions regarding publication date, language, or status applied. The studies were selected by two independent evaluators, who also extracted the data and assessed the methodological quality following eight criteria related to sampling, measuring blood pressure, and presenting results. The meta-analysis was calculated using a random effects model and analyses were performed to investigate heterogeneity.

RESULTS

We retrieved 1,577 articles from the search and included 22 in the review. The included articles corresponded to 14,115 adolescents, 51.2% (n = 7,230) female. We observed a variety of techniques, equipment, and references used. The prevalence of hypertension was 8.0% (95%CI 5.0-11.0; I2 = 97.6%), 9.3% (95%CI 5.6-13.6; I2 = 96.4%) in males and 6.5% (95%CI 4.2-9.1; I2 = 94.2%) in females. The meta-regression failed to identify the causes of the heterogeneity among studies.

CONCLUSIONS

Despite the differences found in the methodologies of the included studies, the results of this systematic review indicate that hypertension is prevalent in the Brazilian adolescent school population. For future investigations, we suggest the standardization of techniques, equipment, and references, aiming at improving the methodological quality of the studies.

Relationship between body mass index changes and blood pressure changes from childhood to adulthood in a general Chinese population: a 26 year cohort follow-up study

The aim of this study was to estimate the relationship between body mass index (BMI) and blood pressure (BP) in a Chinese population with 26 year follow-up. The study included 4211 schoolchildren aged 6-17 years in Hanzhong, Shaanxi Province, China. Body weight, height, waist circumference, and BP were measured in 1987, 1989, 1992, 1995 and 2013. Cox proportional hazards model were fitted to examine the effect of BMI on BP. At the 26 year follow-up, 6.93% of male and 3.43% of female subjects had high SBP, and 12.8% of male and 4.56% of female had high DBP. The average age of subjects with high SBP was 40.3 years in males and 41.4 years in females; while the average age with high DBP was 38.1 years in males and 38.9 years in females. Obese subjects were 2.96 times and 2.88 times more likely to have high SBP and high DBP than normal weight counterparts, respectively; while overweight subjects were 1.81 times and 2.03 times more likely to have high SBP and high DBP, respectively. These findings underscore the urgent need to prevent increasing body weight. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.

Family socioeconomic factors are negatively associated with blood pressure in European boys, but not girls, and Brazilian adolescents: Results from two observational studies

OBJECTIVE

We aimed to estimate the attributable fraction of systolic (SBP) and diastolic blood pressure (DBP) that can be explained by family socioeconomic factors (FSFs) in adolescents using two observational studies.

METHODS

Participants were recruited by multistage random cluster in two cross-sectional studies performed in Europe [Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, n = 3308] and Brazil [Brazilian Cardiovascular Adolescent Health (BRACAH) study, n = 991]. SBP and DBP were measured, and FSFs (socioeconomic status and parental education) were self-reported in both studies. The correlations of SBP and DBP with FSFs were examined by multilevel linear regression through two different models (hierarchical and fully adjusted). The generalized attributable fractions of the FSFs were estimated by comparing the models.

RESULTS

Our results showed a significant inverse relationship between parental education (father and mother) and SBP in European boys. The higher generalized attributable fraction to SBP was observed in boys (13.2-22.4%). In girls, we found lower generalized attributable fractions to DBP (10.8-12.1% in Brazilian girls and 3.1-3.8% in European girls).

CONCLUSIONS

Our findings revealed a significant inverse relationship between parental education and SBP in European boys. FSF also significantly influenced blood pressure in adolescents, mainly in Brazilian adolescents.

Pathological periodontal pockets are associated with raised diastolic blood pressure in obese adolescents

BACKGROUND

Obesity, a well-known risk factor for developing cardiovascular disease (CVD), is associated with chronic periodontitis in adults. This cross-sectional pilot study on obese adolescents was designed to investigate whether periodontal disease in terms of pathological periodontal pockets is associated with raised blood pressure and other risk markers for CVD.

METHODS

The study included 75 obese subjects between 12 to 18 years of age, mean 14.5. Subjects answered a questionnaire regarding health, oral hygiene habits and sociodemographic factors. A clinical examination included Visible Plaque Index (VPI %), Gingival inflammation (BOP %) and the occurrence of pathological pockets exceeding 4 mm (PD ≥ 4 mm). Blood serum were collected and analyzed. The systolic and diastolic blood pressures were registered.

RESULTS

Adolescents with pathological periodontal pockets (PD ≥ 4 mm; n = 14) had significantly higher BOP >25% (P = 0.002), higher diastolic blood pressure (P = 0.008), higher levels of Interleukin (IL)-6 (P < 0.001), Leptin (P = 0.018), Macrophage Chemoattractant Protein-1 (MCP-1) (P = 0.049) and thyroid stimulating hormone (TSH) (P = 0.004) in blood serum compared with subjects without pathological periodontal pockets (PD ≥ 4 mm; n = 61). The bivariate linear regression analysis demonstrated that PD ≥ 4 mm (P = 0.008) and systolic blood pressure (P < 0.001) were significantly associated with the dependent variable "diastolic blood pressure". The association between PD ≥ 4 mm and diastolic blood pressure remained significant (P = 0.006) even after adjusting for potential confounders BMI-sds, age, gender, mother's country of birth, BOP >25%, IL-6, IL-8, Leptin, MCP-1, TSH and total cholesterol in the multiple regression analysis.

CONCLUSION

In conclusion, this study indicates an association between pathological periodontal pockets and diastolic blood pressure in obese adolescents. The association was unaffected by other risk markers for cardiovascular events or periodontal disease. The results call for collaboration between pediatric dentists and medical physicians in preventing obesity development and its associated disorders.

Potential biases in the classification, analysis and interpretations in cross-sectional study: commentaries - surrounding the article "resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"

BACKGROUND

Resting heart rate reflects sympathetic nerve activity. A significant association between resting heart rate (HR) and all causes of cardiovascular mortality has been reported by some epidemiologic studies. Despite suggestive evidence, resting heart rate (RHR) has not been formally explored as a prognostic factor and potential therapeutic outcome and, therefore, is not generally accepted in adolescents.

DISCUSSION

The core of the debate is the methodological aspects used in "Resting heart rate: its correlations and potential for screening metabolic dysfunctions in adolescents"; the points are: cutoff used for cluster RHR, two different statistical models used to analyze the same set of variables, one for continuous data, and another for categorical data; interpretation of p-value < 0.05, sampling process involving two random stages, analysis of design effect and the parameters of screening tests.

SUMMARY

Aspects that must be taken into account for evaluation of a screening test to measure the potential for discrimination for a common variable (population with outcome vs. no outcome population), the main indicators are: sensitivity, specificity, accuracy, positive predictive value and negative predictive value. The measures of argumentation equality (CI) or difference (p-valor) are important to validate these indicators but do not indicate quality of screening.

[Blood pressure and its association with physical activity and obesity in adolescents: a systematic review]

In the light of the importance of the impacts that obesity and physical activity may have on blood pressure (BP) among adolescents, and the suggestion that abnormal pressure levels at young ages are maintained into more mature stages of these individuals' lives, the scope of this study is to conduct a systematic review of the associations between obesity and BP and between physical activity and BP among adolescents. The PubMed database was consulted to search for scientific articles relating to this topic and, after applying the appropriate inclusion and exclusion criteria, 30 articles were selected and analyzed. To assess the quality of articles Strengthening the Reporting of Observational Studies in Epidemiology was applied. The results suggest that despite the existence of hegemonic thinking to guide these relationships, BP and physical activity do not always have negative associations, and BP and obesity do not always have positive associations. The conclusion reached is that this situation illustrates the need for more in-depth reflection on these relationships before pre-established paradigms are passively accepted.

Childhood and adolescent overweight and obesity in Latin America: a systematic review

The number of children and adolescents who are overweight or obese worldwide is alarming. We did a systematic review to estimate the prevalence of overweight and obesity in children aged 0-19 years in Latin America. We searched specialised databases and seven books for relevant studies that were done in Spanish-speaking and Portuguese-speaking Latin American and Caribbean countries and published in peer-reviewed journals between January 2008, and April 2013. Indicators used were BMI (kg/m(2)) in all age groups and weight-for-height in children younger than 5 years. We identified 692 publications and included 42. Estimated prevalence of overweight in children younger than 5 years in Latin America was 7·1% with the weight-for-height WHO 2006 classification method. National combined prevalences of overweight and obesity with the WHO 2007 classification method ranged from 18·9% to 36·9% in school-age children (5-11 years) and from 16·6% to 35·8% in adolescents (12-19 years). We estimated that 3·8 million children younger than 5 years, 22·2-25·9 million school-age children, and 16·5-21·1 million adolescents were overweight or obese. Overall, between 42·5 and 51·8 million children aged 0-19 years were affected-ie, about 20-25% of the population. Although undernutrition and obesity coexist in the region, policies in most countries favour prevention of undernutrition, and only a few countries have implemented national policies to prevent obesity. In view of the number of children who are overweight or obese, the associated detrimental effects on health, and the cost to health-care systems, implementation of programmes to monitor and prevent unhealthy weight gain in children and adolescents are urgently needed throughout Latin America.

Pressão arterial elevada em adolescentes: prevalência e fatores associados

Objetivou-se verificar a prevalência e os fatores associados à pressão arterial (PA) elevada em adolescentes de um município Brasileiro. Estudo transversal, conduzido em 653 adolescentes (57,9% do sexo feminino) de 14 a 19 anos de idade, estudantes do ensino médio. A Pressão arterial sistólica (PAS) e a diastólica (PAD) foram mensuradas em todos os sujeitos. Variáveis sociodemográficas, do estilo de vida e índice de massa corporal foram obtidas. Regressão logística binária, bruta e ajustada, foi empregada com nível de significância de 5%. A média da PAS e PAD foi de 111,9 mmHg e 69,9 mmHg, respectivamente. A prevalência de PA elevada foi de 12,4%. Na análise multivariável foi identificado que jovens do sexo masculino (OR: 2,37; IC95%: 1,45-3,90), com escolaridade materna de até oito anos (OR: 1,84; IC95%: 1,03-3,30) e com excesso de peso (OR: 3,79; IC95%: 2,23-6,43), apresentaram maiores chances de PA elevada. O termo de interação entre sexo masculino e excesso de peso representou o subgrupo com maiores chances de PA elevada (OR: 6,41; IC95%: 3,00-13,16). Níveis pressóricos elevados acometem adolescentes da cidade de Ponta Grossa, Paraná, e os grupos com maiores chances de PA elevada foram os do sexo masculino, com escolaridade materna baixa e com excesso de peso.

Tratamento multiprofissional da obesidade e sua cessação em adolescentes: efeitos no perfil hemodinâmico

Avaliar os efeitos de um Programa Multiprofissional de Tratamento da Obesidade (PMTO) e de sua cessação sobre o perfil hemodinâmico de adolescentes. Foram avaliados 19 adolescentes com excesso de peso de 10 a 18 anos. Medidas antropométricas, pressão arterial e frequência cardíaca de repouso foram incluídas na análise. Os adolescentes completaram 16 semanas do PMTO com uma equipe multiprofissional focada em promover mudanças no estilo de vida dos adolescentes. Os mesmos retornaram para avaliação após oito semanas de cessação das atividades. Após o PMTO, foi observada redução na frequência cardíaca de repouso nas meninas sem diferença significativa para o momento de cessação. Os meninos apresentaram melhora para as variáveis: circunferência abdominal, IMC, gordura relativa e massa magra após o PMTO. Após o período cessação houve aumento significativo apenas no peso. Os resultados evidenciam o impacto positivo de um PMTO demonstrando efeitos diferentes de acordo com o gênero.

Pediatric ambulatory blood pressure monitoring: indications and interpretations

The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.