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Tao JM, Wei W, Ma XY, Huo YX, Hu MD, Li XF, Chen X. Diagnostic accuracy of anthropometric indices for discriminating elevated blood pressure in pediatric population: a systematic review and a meta-analysis. BMC Pediatr 2022; 22:19. [PMID: 34983442 PMCID: PMC8725266 DOI: 10.1186/s12887-021-03062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population. METHODS MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension. RESULTS 21 cross-sectional studies involving 177,943 children and 3-19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P < 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population. CONCLUSIONS This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. While compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children's early blood pressure abnormalities.
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Affiliation(s)
- Jun-Min Tao
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Wei Wei
- Department of Neurosurgery, Affiliated Dalian Municipal Central Hospital, Dalian Medical University, Dalian, 116033, China
| | - Xiao-Yang Ma
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Ying-Xiang Huo
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Meng-Die Hu
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Xiao-Feng Li
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China
| | - Xin Chen
- Department of Epidemiology, School of Public Health, Dalian Medical University, No. 9, West Section of Lvshun South Road, Lvshunkou District, Dalian City, 116044, Liaoning Provence, China.
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Al Hourani HM, Alkhatib B. Anthropometric indices of obesity as predictors of high blood pressure among school children. Clin Exp Hypertens 2021; 44:11-19. [PMID: 34664528 DOI: 10.1080/10641963.2021.1969662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. The aim of this study was to determine the predictive power of anthropometric indicators and to establish their cutoff points as discriminators of high blood pressure. METHODS A cross-sectional study was conducted on 793 schoolchildren aged 10-14 years. Six anthropometric indices were used: body mass index-z-score (BMI-z-score), waist circumference (WC), waist-toheight ratio (WHtR), a body shape index (ABSI), body roundness index (BRI) and conicity index (CI). Elevated blood pressure (EBP) and hypertension (HTN) were characterized by values ≥ 90th and <95th percentile and ≥ 95th percentile for systolic and/or diastolic blood pressure, respectively. The predictive power of anthropometric indices was analyzed by sex using the receiver operating characteristic curve (ROC). RESULTS The prevalence of EBP and HTN was 11.0% and 14.8%, respectively. According to the analyses of the ROC curve, WC provided the largest area under the curve (AUC) value, while CI showed the lowest AUC value in predicting elevated blood pressure in the total sample. The BMI z-score provided the largest area under the curve (AUC) value (0.722), followed by WHtR (0.709) and BRI (0.709), in predicting hypertension in boys. CONCLUSIONS BMI z-score and WC may be the best predictors of EBP and BMI z-score for HTN among Jordanian schoolchildren.
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Affiliation(s)
- Huda M Al Hourani
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Buthaina Alkhatib
- Department of Clinical Nutrition and Dietetics, Faculty of Science, Philadelphia University, Amman, Jordan
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Liu K, Li C, Gong H, Guo Y, Hou B, Chen L, Liu F, Liu Y, Wang J, Hou Q, Wang Z, Hui R, Jiang X, Zou Y, Zhang Y, Song L. Prevalence and Risk Factors for Hypertension in Adolescents Aged 12 to 17 Years: A School-Based Study in China. Hypertension 2021; 78:1577-1585. [PMID: 34538102 DOI: 10.1161/hypertensionaha.121.17300] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kai Liu
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haibin Gong
- Xuzhou Cardiovascular Disease Institute, Jiangsu, China (H.G.)
| | - Ye Guo
- The First Hospital of Fangshan District, Beijing, China (Y.G.)
| | - Bingjie Hou
- The Fourth Central Hospital of Baoding City, Hebei, China (B.H.)
| | - Liangyu Chen
- The First People's Hospital of Chuzhou, Anhui, China (L.C.)
| | - Fusong Liu
- The Third People's Hospital of Qingdao, Shandong, China (F.L.)
| | - Yajuan Liu
- Central Hospital of Yichun City, Heilongjiang, China (Y.L.)
| | - Jizheng Wang
- State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing Hou
- BestNovo (Beijing) Diagnostics Laboratory, China (Q.H.)
| | - Zengwu Wang
- Division of Prevention and Community Health (Z.W.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Rutai Hui
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiongjing Jiang
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yubao Zou
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuqing Zhang
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lei Song
- Department of Cardiology (K.L., C.L., R.H., X.J., Y. Zou, Y. Zhang, L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,State Key Laboratory of Cardiovascular Disease (J. W., R.H., L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.,National Clinical Research Center of Cardiovascular Diseases (L.S.), National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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ahmadi N, Mahdieh Namayandeh S, Bafghi SMS, Mohammadi MR, Mirzaei M, Sarebanhassanabadi M, Mehrparvar AH, Faraji R, Nilforoshan N, Karimi A. Age-, sex-, and height-based blood pressure reference charts, Yazd children 6-18 years, Iran. Clin Exp Pediatr 2020; 63:321-328. [PMID: 32689764 PMCID: PMC7402986 DOI: 10.3345/cep.2019.00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/01/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Pediatric hypertension is the main cause of morbidity and mortality in pediatric populations. PURPOSE To examine pediatric hypertension in a clinical setting, we used the percentile rank approach and defined hypertension as that above the 95th percentile. METHODS The present study was linked to the a national analytical cross-sectional community-based Iranian Children and Adolescents' Psychiatric Disorders (IRCAP) survey. The survey was nationwide and funded by the National Institute of Medical Research Development. The IRCAP survey included 31,000 children and adolescents aged 6-18 years in all 31 Iran provinces. The current study included 1,035 children and adolescents and linked the data of the risk factors of cardiovascular disease only in Yazd province via random cluster sampling. RESULTS Of the total participants, 456 (44.1%) were male and 579 (55.9%) were female. The mean age was 11.2±3.8 years (11.7±3.7 years for males, 11.0±3.6 years for females), while mean height was 146±20.0 cm overall, 147.2±22.0 cm for males, and 144.6±17.0 cm for females (P=0.009). The blood pressure distributions and percentiles were evaluated. CONCLUSION Here we determined age- and height-specific 50th, 90th, 95th, and 99th percentiles of systolic and diastolic blood pressures in Yazd boys and girls using 10-cm height intervals.
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Affiliation(s)
- Nastaran ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyedeh Mahdieh Namayandeh
- Yazd Cardiovascular Research Center, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyed Mahmood Sadr Bafghi
- Yazd Cardiovascular Research Center, Health Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Reza Faraji
- Krmanshah Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ahmad Karimi
- Research Center of Prevention and Epidemiology of Non-Communicable Disease, Departments of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Communicable Disease Surveillance, Abadeh Health Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Yazdi M, Assadi F, Qorbani M, Daniali SS, Heshmat R, Esmaeil Motlagh M, Kelishadi R. Validity of anthropometric indices in predicting high blood pressure risk factors in Iranian children and adolescents: CASPIAN-V study. J Clin Hypertens (Greenwich) 2020; 22:1009-1017. [PMID: 32506679 PMCID: PMC8029738 DOI: 10.1111/jch.13895] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023]
Abstract
Anthropometric indices have been used as indicators for predicting hypertension (HTN) in children and adolescents but it is not clear which anthropometric measures are a better index for identifying elevated blood pressure (EBP) risk factors in pediatric population. Body mass index (BMI), waist circumference (WC), weight-height ratio (WHR), a body shape index (ABSI) and blood pressure were measured in 14 008 children and adolescents aged 7-18 years in a national school-aged survey CASPIN V. Hypertension (HTN) was defined according to the 2017 American Academy of Pediatrics guidelines, using the 95th percentile. The predictive power of anthropometric indices for HTN risk factors was examined using receiver operating characteristic (ROC) analyses. Multivariate logistic regression analysis was used to compare areas under ROC curves (AUCs) among the four anthropometric indices. BMI, WC, WHR, and ABSI were significantly higher in adolescents than in children. EBP was more prevalent in boys (7.2%) than girls (5.5%), whereas the prevalence of HTN was higher in girls (11.3%) than boys 10.4%. Prevalence odds ratio was around 2 for BMI, WC, and WHR with AUCs scores of nearly 0.6 to predict EBP in both children and adolescents of both sexes. Thus, the ability of BMI z-score, WC, WHR or ASBI to identify Iranian children and adolescents at higher risk of EBP was week. WC, WHR or ASBI in combination with BMI did not improve predictive power to identify subjects at higher risk of EBP.
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Affiliation(s)
- Mayram Yazdi
- Child Growth and Development Research CenterResearch Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
| | - Farahnak Assadi
- Department of PediatricsRush University Medical CollegeChicagoILUSA
| | - Mostafa Qorbani
- Non‐Communicable Diseases Research CenterAlborz University of Medical SciencesKarajIran
- Chronic Research CenterEpidemiology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Seyede Shahbanoo Daniali
- Child Growth and Development Research CenterResearch Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
| | - Ramin Heshmat
- Chronic Diseases Research CenterEndocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | | | - Roya Kelishadi
- Child Growth and Development Research CenterResearch Institute for Primordial Prevention of Non‐Communicable DiseaseIsfahan University of Medical SciencesIsfahanIran
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The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children. Br J Nutr 2020; 123:1043-1055. [PMID: 31964435 DOI: 10.1017/s0007114520000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BMI, waist circumference (WC) and waist-to-height ratio (WHtR) can be used for discriminating children and adolescents at risk of CVD. However, consensus on how to use these anthropometric indicators is lacking for children and adolescents in Asia. Discrete criteria are promoted internationally, but continuous variables could be used. Data from a survey of 10 949 Vietnamese school-aged children (6-18 years) were used to evaluate the performance of anthropometric indicators to identify elevated blood pressure (BP), dyslipidaemia or at least three cardiovascular risk factors (CVRF). Weight, height, WC and BP were measured using standardised protocols; 1009 participants who had blood lipids were analysed. AUC was used to assess the performance, and the Youden index to identify optimal cut-offs. The prevalence of elevated BP, dyslipidaemia and CVRF was 26·5, 49·3 and 12·2 %, respectively. BMI, WC and WHtR had low capacity to identify elevated BP and dyslipidaemia (AUC range 0·61-0·66) but moderate capacity to identify CVRF (0·72-0·74). Optimal BMIZ cut-offs to identify elevated BP, dyslipidaemia and CVRF were 0·40, 1·01 and 1·1 sd; for WC z-score, they were 0·06, 0·49 and 0·62 sd; for WHtR, optimal cut-offs were close to 0·5. A BMIZ cut-off of 1·0 sd and a WHtR cut-off of 0·5 would, therefore, be useful criteria to identify Vietnamese children who are likely to have CVRF. However, further validation of these criteria in other studies of Asian children and adolescents is needed.
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Tee JYH, Gan WY, Lim PY. Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: a cross-sectional study. BMJ Open 2020; 10:e032874. [PMID: 31932391 PMCID: PMC7044891 DOI: 10.1136/bmjopen-2019-032874] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To compare the performance of different anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and a body shape index to predict high blood pressure (BP) in adolescents using the 90th and 95th percentiles as two different thresholds. DESIGN Cross-sectional study. SETTING Probability proportionate to size was used to randomly select two schools in Selangor state, Malaysia. PARTICIPANTS A total of 513 adolescents (58.9% women and 41.1% men) aged 12-16 years were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES Weight, height, WC and BP of the adolescents were measured. The predictive power of anthropometric indices was analysed by sex using the receiver operating characteristic curve. RESULTS BMI and WHtR were the indices with higher areas under the curve (AUCs), yet the optimal cut-offs to predict high BP using the 95th percentile were higher than the threshold for overweight/obesity. Most indices showed poor sensitivity under the suggested cut-offs. In contrast, the optimal BMI and WHtR cut-offs to predict high BP using the 90th percentile were lower (men: BMI-for-age=0.79, WHtR=0.46; women: BMI-for-age=0.92, WHtR=0.45). BMI showed the highest AUC in both sexes but had poor sensitivity among women. WHtR presented good sensitivity and specificity in both sexes. CONCLUSIONS These findings suggested that WHtR might be a useful indicator for screening high blood pressure risk in the routine primary-level health services for adolescents. Future studies are warranted to involve a larger sample size to confirm these findings.
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Affiliation(s)
- Joyce Ying Hui Tee
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Wan Ying Gan
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. J Hum Hypertens 2018; 32:789-798. [DOI: 10.1038/s41371-018-0088-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 11/08/2022]
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Tian C, Xu S, Wang H, Wang W, Shen H. Blood pressure effects of adiposity in non-overweight children aged 6-17 years. Ann Hum Biol 2017; 44:644-647. [PMID: 28866960 DOI: 10.1080/03014460.2017.1375557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Obesity is a well-established risk factor of elevated blood pressure; however, the relationships between normal weight status and the risk of hypertension and pre-hypertension are not clear. AIM The aim of this study is to describe the blood pressure effects of adiposity in non-overweight children. METHODS AND RESULTS In total, 588 097 non-overweight children aged 6-17 years were included from the National Surveys on Students' Constitution and Health. A non-linear relationship was found between age- and gender-standardised body mass index (BMI) z-score and pre-hypertension and hypertension, respectively. The odds ratios and 95% confidence intervals [ORs (95% CIs)] of pre-hypertension were 0.61 (0.59-0.63), 0.67 (0.65-0.68), 0.83 (0.83-0.84), 1.00 (reference), 1.13 (1.12-1.14), 1.18 (1.16-1.20) and 1.20 (1.18-1.22) for BMI z-scores of -1.2, -1.0, -0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The ORs (95% CIs) of hypertension were 0.56 (0.54-0.58), 0.62 (0.61-0.64), 0.81 (0.80-0.82), 1.00 (reference), 1.17 (1.16-1.18), 1.23 (1.22-1.5) and 1.27 (1.24-1.29) for BMI z-scores of -1.2, -1.0, -0.5, 0 (reference), 0.5, 0.7 and 0.8, respectively. The above-mentioned associations were consistent in sub-group analysis by age, gender and height. CONCLUSIONS Non-linear relationships of BMI z-scores with pre-hypertension and hypertension were found in non-overweight children. Interventions to control blood pressure are also important in non-overweight children.
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Affiliation(s)
- Changwei Tian
- a Department of Acute Infectious Disease Control and School Health , Kunshan Centers for Disease Control and Prevention , Suzhou , Jiangsu , PR China
| | - Shuang Xu
- a Department of Acute Infectious Disease Control and School Health , Kunshan Centers for Disease Control and Prevention , Suzhou , Jiangsu , PR China
| | - Hua Wang
- a Department of Acute Infectious Disease Control and School Health , Kunshan Centers for Disease Control and Prevention , Suzhou , Jiangsu , PR China
| | - Wenming Wang
- a Department of Acute Infectious Disease Control and School Health , Kunshan Centers for Disease Control and Prevention , Suzhou , Jiangsu , PR China
| | - Hui Shen
- b Department of School Health , Suzhou Centers for Disease Control and Prevention , Suzhou , Jiangsu , PR China
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Yang Y, Dong B, Wang S, Dong Y, Zou Z, Fu L, Ma J. Prevalence of high blood pressure subtypes and its associations with BMI in Chinese children: a national cross-sectional survey. BMC Public Health 2017. [PMID: 28651555 PMCID: PMC5485696 DOI: 10.1186/s12889-017-4522-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Data on prevalence and characteristics of different high blood pressure subtypes are lacking among Chinese children. Regarding the mechanistic differences between isolated systolic high blood pressure and isolated diastolic high blood pressure and their different impact on end organ diseases, it is necessary to examine the prevalence of different high blood pressure subtypes in Chinese children and explore their associations with adiposity. Methods Data were derived from the baseline data of a multi-centered cluster randomized controlled trial involving participants from China. High blood pressure was defined according to age-, gender- and height-specific 95th percentile developed by the National High Blood Pressure Education Program Working Group. Body mass index was used to classify underweight, normal weight, overweight and obesity. Results The prevalence of HBP was 10.2% and 8.9% for boys and girls, respectively. Isolated systolic high blood pressure is the dominant high blood pressure subtype among Chinese boys aged 6–17 years and girls aged 12–17 years, while isolated diastolic high blood pressure was the most common high blood pressure subtype in girls aged 6–11 years. In boys, the status of overweight doubled the risk of isolated systolic high blood pressure (95% CI, 1.73, 2.31; P < 0.001) compared with the normal weight group, and the risk for obese children was 4.32 (95% CI, 3.81, 4.90; P < 0.001). The corresponding odds ratios in girls were 2.04 (95% CI, 1.68, 2.48, P < 0.001) for overweight, and 4.0 (95% CI, 3.36, 4.76, P < 0.001) for obesity. Similar patterns were also observed in the association between combined systolic and diastolic high blood pressure and adiposity. Conclusion The distribution of high blood pressure subtypes in boys differed from those in girls, and boys with adiposity showed a higher risk of high blood pressure than their female counterpart. Difference in strength of association between isolated diastolic high blood pressure and isolated systolic high blood pressure with body mass index was also found. These results may aid current strategies for preventing and controlling pediatric hypertension. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4522-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yide Yang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.,Centre for Chronic Disease, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Shuo Wang
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Zhiyong Zou
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China
| | - Lianguo Fu
- Department of Preventive Medicine, Bengbu Medical College, Bengbu, Anhui, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
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Wang LY, Liu Q, Cheng XT, Jiang JJ, Wang H. Blood pressure-to-height ratio as a screening indicator of elevated blood pressure among children and adolescents in Chongqing, China. J Hum Hypertens 2016; 31:438-443. [PMID: 28032627 DOI: 10.1038/jhh.2016.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/12/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022]
Abstract
We aimed to evaluate the performance of blood pressure-to-height ratio (BPHR) and establish their optimal thresholds for elevated blood pressure (BP) among children aged 6 to 17 years in Chongqing, China. Data were collected from 11 029 children and adolescents aged 6-17 years in 12 schools in Chongqing according to multistage stratified cluster sampling method. The gold standard for elevated BP was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ⩾95th percentile for gender, age and height. The diagnostic performance of systolic BPHR (SBPHR) and diastolic BPHR (DBPHR) to screen for elevated BP was evaluated through receiver-operating characteristic curves (including the area under the curve (AUC) and its 95% confidence interval, sensitivity and specificity). The prevalence of elevated BP in children and adolescents in Chongqing was 10.36% by SBP and/or DBP ⩾95th percentile for gender, age and height. The optimal thresholds of SBPHR/DBPHR for identifying elevated BP were 0.86/0.58 for boys and 0.85/0.57 for girls among children aged 6 to 8 years, 0.81/0.53 for boys and 0.80/0.52 for girls among children aged 9 to 11 years and 0.71/0.45 for boys and 0.72/0.47 for girls among adolescents aged 12-17 years, respectively. Across gender and the specified age groups, AUC ranged from 0.82 to 0.88, sensitivity were above 0.94 and the specificities were over 0.7. The positive predictive values ranged from 0.30 to 0.38 and the negative predictive values were ⩾0.99. BPHR, with uniform values across broad age groups (6-8, 9-11 and 12-17 years) for boys and for girls is a simple indicator to screen elevated BP in children and adolescents in Chongqing.
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Affiliation(s)
- L Y Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Q Liu
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - X T Cheng
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - J J Jiang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - H Wang
- Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.,Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Lo K, Wong M, Khalechelvam P, Tam W. Waist-to-height ratio, body mass index and waist circumference for screening paediatric cardio-metabolic risk factors: a meta-analysis. Obes Rev 2016; 17:1258-1275. [PMID: 27452904 DOI: 10.1111/obr.12456] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/17/2016] [Accepted: 06/29/2016] [Indexed: 02/01/2023]
Abstract
Waist-to-height ratio (WHtR) is superior to body mass index and waist circumference for measuring adult cardio-metabolic risk factors. However, there is no meta-analysis to evaluate its discriminatory power in children and adolescents. A meta-analysis was conducted using multiple databases, including Embase and Medline. Studies were included that utilized receiver-operating characteristics curve analysis and published area under the receiver-operating characteristics curves (AUC) for adiposity indicators with hyperglycaemia, elevated blood pressure, dyslipidemia, metabolic syndrome and other cardio-metabolic outcomes. Thirty-four studies met the inclusion criteria. AUC values were extracted and pooled using a random-effects model and were weighted using the inverse variance method. The mean AUC values for each index were greater than 0.6 for most outcomes including hypertension. The values were the highest when screening for metabolic syndrome (AUC > 0.8). WHtR did not have significantly better screening power than other two indexes in most outcomes, except for elevated triglycerides when compared with body mass index and high metabolic risk score when compared with waist circumference. Although not being superior in discriminatory power, WHtR is convenient in terms of measurement and interpretation, which is advantageous in practice and allows for the quick identification of children with cardio-metabolic risk factors at an early age.
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Affiliation(s)
- K Lo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - M Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - P Khalechelvam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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