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Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, Norris SA, Ware LJ. Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis. EClinicalMedicine 2022; 43:101229. [PMID: 34917909 PMCID: PMC8665406 DOI: 10.1016/j.eclinm.2021.101229] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. METHODS We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic. FINDINGS In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. INTERPRETATION Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. FUNDING This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
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Affiliation(s)
- Simone H. Crouch
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M. Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Correspondence and reprint to: Dr. Larske M. Soepnel. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Huispost nr. STR 6.131 P.O. Box 85500 3508 GA, Utrecht, The Netherlands
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa School of Public Health
| | - Sanushka Naidoo
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Davies
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Hsu CY, Chen LS, Chang IJ, Fang WC, Huang SW, Lin RH, Ueng SWN, Chuang HH. Can Anthropometry and Body Composition Explain Physical Fitness Levels in School-Aged Children? CHILDREN (BASEL, SWITZERLAND) 2021; 8:460. [PMID: 34072785 PMCID: PMC8229107 DOI: 10.3390/children8060460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Physical fitness (PF) is closely related to various health outcomes and quality of life among children. However, the associations between anthropometry, body composition (BC), and PF are not fully elucidated. This cross-sectional study aimed to investigate the associations between demographic metrics (age, sex), anthropometric measures (body mass index z-score (BMI z-score) waist/height ratio (WHtR)), BC parameters (body-fat percentage (BF%), muscle weight), and PF levels (800-m run, sit-and-reach, 1-min sit-ups, standing long jump) in school-aged children. Continuous variables were dichotomized by median splits. The results of 180 girls and 180 boys (mean age: 10.0 ± 0.7 years; mean BMI z-score: 0.366 ± 1.216) were analyzed. Multivariable linear regressions revealed that BF% (regression coefficient (B) = 3.4, 95% confidence interval (CI) = 2.5-4.3) was independently correlated with the 800-m run. Sex (B = 4.6, 95% CI = 3.0-6.3), age (B = 3.1, 95% CI = 1.9-4.3), and BMI z-score (B = -0.7, 95% CI = -1.4--0.1) were independently related to sit-and-reach. Age (B = 3.3, 95% CI = 2.0-4.7), BF% (B = -0.3, 95% CI = -0.4--0.2), and muscle weight (B = 0.7, 95% CI = 0.2-1.2) were independently associated with 1-min sit-ups. In addition to demography, anthropometry and BC provided additional information concerning some PF levels in school-aged children. Weight management and PF promotion should be addressed simultaneously in terms of preventive medicine and health promotion for children.
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Affiliation(s)
- Chih-Yu Hsu
- Department of Family Medicine, Linkou and Taipei Branches, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-Y.H.); (L.-S.C.); (I.-J.C.); (W.-C.F.)
| | - Liang-Sien Chen
- Department of Family Medicine, Linkou and Taipei Branches, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-Y.H.); (L.-S.C.); (I.-J.C.); (W.-C.F.)
| | - I-Jen Chang
- Department of Family Medicine, Linkou and Taipei Branches, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-Y.H.); (L.-S.C.); (I.-J.C.); (W.-C.F.)
| | - Wei-Ching Fang
- Department of Family Medicine, Linkou and Taipei Branches, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-Y.H.); (L.-S.C.); (I.-J.C.); (W.-C.F.)
| | - Sun-Weng Huang
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan; (S.-W.H.); (R.-H.L.)
- Graduate Institute of Urban Planning, College of Public Affairs, National Taipei University, New Taipei City 23741, Taiwan
| | - Rong-Ho Lin
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan; (S.-W.H.); (R.-H.L.)
| | - Steve Wen-Neng Ueng
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Orthopedic Surgery, Linkou Main Branch, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Linkou and Taipei Branches, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan; (C.-Y.H.); (L.-S.C.); (I.-J.C.); (W.-C.F.)
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan; (S.-W.H.); (R.-H.L.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Obesity Institute, Geisinger, Danville, PA 17837, USA
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Hsu CY, Lin RH, Lin YC, Chen JY, Li WC, Lee LA, Liu KH, Chuang HH. Are Body Composition Parameters Better than Conventional Anthropometric Measures in Predicting Pediatric Hypertension? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5771. [PMID: 32785000 PMCID: PMC7460262 DOI: 10.3390/ijerph17165771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 12/03/2022]
Abstract
Body composition (BC) parameters are associated with cardiometabolic diseases in children; however, the importance of BC parameters for predicting pediatric hypertension is inconclusive. This cross-sectional study aimed to compare the difference in predictive values of BC parameters and conventional anthropometric measures for pediatric hypertension in school-aged children. A total of 340 children (177 girls and 163 boys) with a mean age of 8.8 ± 1.7 years and mean body mass index (BMI) z-score of 0.50 ± 1.24 were enrolled (102 hypertensive children and 238 normotensive children). Significantly higher values of anthropometric measures (BMI, BMI z-score, BMI percentile, waist-to-height ratio) and BC parameters (body-fat percentage, muscle weight, fat mass, fat-free mass) were observed among the hypertensive subgroup compared to their normotensive counterparts. A prediction model combining fat mass ≥ 3.65 kg and fat-free mass ≥ 34.65 kg (area under the receiver operating characteristic curve = 0.688; sensitivity = 66.7%; specificity = 89.9%) performed better than BMI alone (area under the receiver operating characteristic curve = 0.649; sensitivity = 55.9%; specificity = 73.9%) in predicting hypertension. In conclusion, BC parameters are better than anthropometric measures in predicting pediatric hypertension. BC measuring is a reasonable approach for risk stratification in pediatric hypertension.
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Affiliation(s)
- Chih-Yu Hsu
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
| | - Rong-Ho Lin
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan;
| | - Yu-Ching Lin
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Department of Imaging and Intervention, Chang Gang Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Department of Otorhinolaryngology—Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- Sleep Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan;
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou and Taipei Branches, Taoyuan 33305, Taiwan; (C.-Y.H.); (J.-Y.C.); (W.-C.L.)
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 10608, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (Y.-C.L.); (L.-A.L.)
- Obesity Institute & Genomic Medicine Institute, Geisinger, Danville, PA 17837, USA
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Using blood pressure height index to define hypertension among secondary school adolescents in southwestern Uganda. J Hum Hypertens 2019; 34:76-81. [PMID: 31792440 DOI: 10.1038/s41371-019-0292-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/10/2019] [Accepted: 11/20/2019] [Indexed: 01/26/2023]
Abstract
Hypertension is the number one risk factor for cardiovascular diseases worldwide and yet its diagnosis among adolescents, based on blood pressure percentiles which are age, height, and sex-specific, is complex. Our study intended to determine the suitability of blood pressure height index in defining adolescent hypertension among secondary school adolescents aged 12-17 years in Mbarara municipality, southwestern Uganda. Our study used data of 485 secondary school adolescents of which 173 were boys. Receiver operating characteristic curve analysis was performed to assess the performance of systolic blood pressure height index (SBPHI) and diastolic blood pressure height index (DBPHI) for screening for adolescent prehypertension and hypertension. The optimal systolic/diastolic thresholds for defining prehypertension were 0.70/0.43 mmHg/cm in boys and 0.76/0.43 in girls. The corresponding values for hypertension were 0.78/0.43 and 0.77/0.48 mmHg/cm, respectively. The negative predictive values were much higher (all ≥ 95%) for prehypertension and hypertension, while the positive predictive value was 100% for hypertension in both sexes. In conclusion, Blood pressure height index is simple and accurate for screening for prehypertension and hypertension in adolescents aged 12-17 years hence can be used for early screening of adolescents at high risk of hypertension but not its diagnosis.
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Çöl N, Kilinc A, Demircioğlu-Kılıç B, Aydin N, Keskin M, Balat A. Predictive value of the “Blood Pressure To Height Ratio” in diagnosis of prehypertension and hypertension during childhood in Southeastern Turkey. Clin Exp Hypertens 2019. [DOI: 10.1080/10641963.2018.1433198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nilgün Çöl
- Department of Social Pediatrics, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Arda Kilinc
- Intensive Care Unit, School of Medicine, Ege University, İzmir, Turkey
| | | | - Neriman Aydin
- Department of Public Health, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Keskin
- Department of Pediatric Endocrinology, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ayse Balat
- Department of Pediatric Nephrology, School of Medicine, İstanbul Aydın University, İstanbul, Turkey
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