Relations between obesity and hypertension: preliminary data from a cross-sectional study in primary schoolchildren: The children study

Gender differences and climate zones in overweight and obesity prevalence in European elementary school children from 2000 to 2020: a systematic review and meta-analysis

Introduction

After 2000, there are more obese than underweight people in the world. We face a rapid increase in average global warming of 1.5°C, reported as a syndemic problem of three interconnected epidemics: obesity, global warming, and undernutrition. We aimed to analyze the impact and association between global warming and obesity in children and differences by gender across Europe after 2000.

Methods

We searched PubMed, MEDLINE, Google Scholar, ScienceDirect, and Embase databases. The considered population were children aged 6-14. Only cross-sectional studies that defined obesity by the IOTF cutoffs and the subjects' place of residence, used to determine precise climate zones, were included. We assessed the prevalence of obesity and overweight using a random-effects and the Mantel-Haenszel fixed-effect method when heterogeneity was greater/lower than 50%. We did a subgroup analysis for prevalence across gender, obesity, and overweight, two decades, regions, countries, and the Köppen-Geiger climate zones. Random effects of the meta-regression were used to study the global warming impact and differences in trends across European countries by gender for both conditions separately.

Results

We identified 114 studies that included 985,971 children from 39 European countries. A significant difference between genders was in favor of obese girls 4.78 (95% CI: 3.85-5.93) versus boys 5.76% (95% CI: 5.11-6.48, p = 0.03), respectively, but not for overweight children. Most of the obese girls were in South Europe 7.51% (95% CI: 6.61-8.51) versus East Europe 2.86% (95% CI: 23-3.12), versus boys in South Europe 8.66% (95% CI: 7.68-9.74) and North Europe 3.49% (95% CI: 2.90-4.19), respectively. The "cold" Köppen-Geiger climate zone, with lowest temperatures, has the largest trend rise between two decades of 2.8% and 1.53% for obese girls and boys, and 5.31% and 1.81% for overweight girls and boys, respectively, followed by the smallest number of obese girls 3.28% (95% CI: 2.17-4.92) and boys 3.58% (95% CI: 2.39-5.33), versus the zone with the highest temperatures "hot" for girls 7.02% (95% CI: 6.30-7.82) and for boys 8.23% (95% CI: 7.55-8.96), respectively. The meta-regression proved global warming has a significant impact on the distribution of obesity and overweight across climate zones, R2 = 0.52 and R2 = 0.22. No significant gender differences, or significant interaction, was noted.

Conclusion

Our meta-analysis provides a comprehensive overview of the association between and impact of global warming on obesity. This impact increases obesity among children in Europe throughout all climate zones, and emphasizes an urgent call for further preventive methods in schools, since obesity differences continue their trend of disappearing into the future.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021282127, identifier: CRD42021282127.

Factors Associated with Primary Hypertension in Pediatric Patients: An Up-to-Date

BACKGROUND

Arterial hypertension in children is considered a common alteration nowadays, mainly because obesity is a growing worldwide problem closely related to increased blood pressure. Childhood hypertension can be classified as primary or secondary, depending on the etiology. Primary or essential hypertension still has its pathophysiology not fully elucidated, and there is no consensus in the literature on most underlying mechanisms. In this review, genetic and environmental factors, including sodium and potassium intake, socioeconomic status, ethnicity, family structure, obesity, sedentary lifestyle, prematurity and low birth weight, prenatal and postnatal exposures are highlighted.

OBJECTIVE

The present study aimed to perform an update on primary hypertension in childhood, providing clinicians and researchers an overview of the current state of the literature regarding the influence of genetic and environmental factors.

METHODS

This integrative review searched for articles on genetic and environmental factors related to primary hypertension in pediatric patients. The databases evaluated were PubMed and Scopus.

RESULTS

The studies have provided insights regarding many genetic and environmental factors, in addition to their association with the pathophysiology of primary hypertension in childhood. Findings corroborated the idea that primary hypertension is a multifactorial disease. Further studies in the pediatric population are needed to elucidate the underlying mechanisms.

CONCLUSION

The study of primary hypertension in pediatrics has utmost importance for the adoption of preventive measures and the development of more efficient treatments, therefore reducing childhood morbidity and the incidence of cardiovascular diseases and other health consequences later in life.

A cross-sectional study on the relationship between the risk of hypertension and obesity status among pre-adolescent girls from rural areas of Southeastern region of the United States

This study investigated early indications of hypertension risk and the association of overweight and obesity in young girls from a low socioeconomic region of the rural South. 139 females (M age = 8.85 ± 1.67 years) from a rural school in the Southeastern region of the United States served as participants. Body mass index was calculated based on the child's height and weight measurements (kg/m2) and resting blood pressure measurements were taken with calibrated, automatic oscillations devices. Girls who were overweight or obese were 2.81 times more likely to have a systolic blood pressure indicative of being at-risk/hypertensive (i.e., pre-hypertension and/or hypertension stage 1) than girls who were not overweight/obese. In fact, the percentage of overweight/obese girls who were at-risk/hypertensive was double that of girls who were not overweight/obese (43.2% versus 21.3%), respectively. Being overweight or obese is associated with almost three times a higher risk of hypertension than girls who are not overweight or obese.

Prevalence of childhood hypertension and hypertension phenotypes by weight status and waist circumference: the Healthy Growth Study

PURPOSE

The aim of the present study was to report for the first time the prevalence of hypertension and its phenotypes in obese children and in children with central obesity in a large sample of Greek children.

METHODS

A regionally representative sample of 2263 schoolchildren (50.3% boys) (9-13 years) having full data on blood pressure assessment, physical examination, anthropometric, and physical activity participated in a cross-sectional study in Greece.

RESULTS

Prevalence of stage 1 and 2 hypertension, of isolated systolic hypertension (ISH) and of combined systolic or diastolic hypertension, was significantly higher for obese children and children on the 3rd tertile of waist circumference in the total sample, as well as in each gender separately. ISH was the most prevalent phenotype reaching 24.3% in obese children and 17.5% in children on the highest tertile of waist circumference. Obese children and children on the highest tertile of waist circumference had 6.31 times and 3.94 times, respectively, higher likelihood to have abnormal systolic or diastolic blood pressure (SBP or DBP) than their normal-weight counterparts.

CONCLUSIONS

Prevalence of hypertension and especially ISH in obese children and in children with central obesity in Greece are among the highest reported in Europe. Future public health initiatives should aim to prevent or tackle several underlying factors related to childhood hypertension, focusing primarily on children with excess body weight.

Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study

BACKGROUND AND AIMS

Childhood hypertension is a constantly increasing health problem. Data regarding its prevalence and particularly the prevalence of its phenotypes in the Greek population are limited; therefore, the aim of the study was to determine them in a large sample of Greek children.

METHODS

A sample of 2655 schoolchildren (9-13 years) participated in the Healthy Growth Study, i.e. a cross-sectional epidemiologic study conducted in 77 primary schools in four large regions in Greece. This study shows results on 2571 children (1286 boys), for whom full data on systolic and diastolic blood pressure indices were available, as well as physical examination, anthropometric and physical activity data.

RESULTS

The observed prevalence rates were: prehypertension, 14.2%; stage 1 hypertension, 15.7%; and stage 2 hypertension, 7.3%. Girls had substantially higher hypertension prevalence than boys (25.3% vs. 20.8%). The prevalence rates for prehypertension and stage 2 hypertension were higher in younger than older children (22.4 vs. 13.7% and 8.6 vs. 7.5% respectively), while stage 1 hypertension was higher in children >12 years old compared to younger children (14.9 vs. 12.1%). Isolated systolic hypertension (ISH) was the most prevalent phenotype (11.9%). Moreover, presence of hypertension was positively associated with body mass index (BMI) and waist circumference in both genders, and with sedentary behaviors only in boys.

CONCLUSIONS

The prevalence of hypertension in Greek children and adolescents is alarming and among the highest reported in European countries, while the differences between genders in hypertension phenotype prevalence also provide valuable insight on this problem. The present data may guide future public health initiatives to tackle childhood hypertension in Greece.

Associations of Apolipoprotein A, High-Sensitivity C-Reactive Protein and Fasting Plasma Insulin in Obese Children With and Without Family History of Cardiovascular Disease

BACKGROUND

The worldwide prevalence of childhood obesity has increased from 4.2% to 6.7% during the last two decades. Pediatric obesity is a major health problem, which is dramatically increasing in Greece. A variety of inflammatory variables have been also found to associate with cardiometabolic (CV) risk in obese children. The purpose of this study was to identify and examine the effects of possible CV risk factors in obese and non-obese children with and without family history (FH) of cardiovascular disease (CVD).

METHODS

Sixty-eight (68) healthy children and adolescents aged 7 - 13 years participated in the study. Anthropometrical and biochemical indexes were obtained from all children as well as FH of CVD.

RESULTS

Systolic blood pressure (SBP), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hsCRP), fasting plasma insulin (FPI) and homeostasis model assessment of insulin resistance (HOMA-IR) levels were found statistically significantly higher in the obese group compared to the non-obese one. High-density lipoprotein (HDL) levels were observed to be statistically significantly lower in the obese children compared to their normal peers.

CONCLUSIONS

Apolipoprotein A, hsCRP and FPI levels were significantly higher in the obese children with FH of CVD compared to the ones without FH of CVD. TC and SBP were found to be independently associated with obesity (odds ratio (OR): 1.965, 95% confidence interval (CI): 1.935 - 2.97, P < 0.031 and OR: 1.045, 95% CI: 1.016 - 1.074, P < 0.002, respectively).

Evaluation of physical activity interventions in children via the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework: A systematic review of randomized and non-randomized trials

CONTEXT

Existing reviews of physical activity (PA) interventions designed to increase PA behavior exclusively in children (ages 5 to 11years) focus primarily on the efficacy (e.g., internal validity) of the interventions without addressing the applicability of the results in terms of generalizability and translatability (e.g., external validity).

OBJECTIVE

This review used the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) framework to measure the degree to which randomized and non-randomized PA interventions in children report on internal and external validity factors.

METHODS AND RESULTS

A systematic search for controlled interventions conducted within the past 12years identified 78 studies that met the inclusion criteria. Based on the RE-AIM criteria, most of the studies focused on elements of internal validity (e.g., sample size, intervention location and efficacy/effectiveness) with minimal reporting of external validity indicators (e.g., representativeness of participants, start-up costs, protocol fidelity and sustainability).

CONCLUSIONS

Results of this RE-AIM review emphasize the need for future PA interventions in children to report on real-world challenges and limitations, and to highlight considerations for translating evidence-based results into health promotion practice.

Prevalence of hypertension in primary school-children in Port Harcourt, Nigeria

BACKGROUND

Hypertension is defined as average systolic and/or diastolic blood pressure (BP) ≥95th per centile for gender, age and height, and pre-hypertension as ≥90th and <95th per centile, measured on three occasions. Although the prevalence of hypertension during childhood is lower than that in adulthood, it is not rare in children.

AIMS AND OBJECTIVES

To evaluate the prevalence of hypertension and its severity in primary school-children in Port Harcourt.

METHODS

A stratified, multi-staged sampling technique was used to recruit pupils between 6 and 12 years of age in 13 primary schools. Data were collected using a pre-tested questionnaire completed by parents/guardians. The average of three blood pressure measurements was taken for each pupil using standardized techniques.

RESULTS

A total of 1302 pupils of whom 585 (44·9%) males and 717 (55·1%) females were studied, giving a male to female ratio of 1:1·2. The prevalence of hypertension was 61 (4·7%), 55 (4·2%) with stage 1 and six (0·5%) with stage 2 hypertension. Sixty (4·6%) of the pupils had pre-hypertension. Twenty-three (3·9%) of the 585 males and 38 (5·3%) of the 717 females were hypertensive (P = 0·25). The mean (SD) age of 8·83 (1·90) years for the normotensive children was higher than the mean (SD) age of 8·56 (2·05) years for the hypertensive children (P = 0·27). Of the study subjects, 152 (11·7%) were underweight, 998 (76·7%) were of normal weight, 75 (5·7%) were overweight and 77 (5·9%) were obese. The prevalence of hypertension among the different weight groups fell steadily from 13 (16·9%) in the obese children to 4 (5·3%) in the overweight children, to 43 (4·3%) in the normal weight children and one (0·7%) in the underweight children (P<0·001).

CONCLUSION

The prevalence of hypertension in school-children in Port Harcourt is 4·7% which is similar to that in other studies in Nigeria and elsewhere. A higher BMI was significantly associated with a higher prevalence of hypertension.

Correlation of blood pressure, obesity, and adherence to the Mediterranean diet with indices of arterial stiffness in children

The aim of the study was to assess the hypothesis that obesity, blood pressure (BP), and dietary habits (adherence to the Mediterranean diet) are related to indices of arterial stiffness (AS) in childhood. Two hundred and seventy-seven children aged 12 years were measured with the R6.5 Pulsecor® monitor, which performs measurements using an upper arm BP cuff held at above systolic pressure for a short time. The augmentation index (AI) in the brachial artery, the peripheral pulse pressure to central pulse pressure (PPP/CPP) ratio, and the reflected wave transit time to height ratio were used as indices of AS. The degree of adherence to the Mediterranean diet was assessed by the KIDMED index which includes 16 questions on specific dietary habits. Forty-three percent of the children were overweight and obese. Overweight and obese children had significantly lower PPP/CPP and KIDMED score in comparison to children with normal body mass index (BMI). In multivariate regression models, indices of AS were related to mean peripheral BP, heart rate, and height, while BMI had an independent correlation to PPP/CPP. The KIDMED index also had a negative correlation with AI independently of obesity.

CONCLUSION

Obesity and adherence to the Mediterranean diet patterns are factors related independently to indices of AS even in 12-year-old children.

Anger, stress and blood pressure in overweight children

Among adults, trait anger, patterns of anger expression, and stress have been associated with blood pressure (BP). Less apparent is the effect of these variables on BP in overweight and obese children. To characterize the relationships between these psychological variables and BP, the authors conducted a secondary analysis of data from 73 overweight and obese 9- to 11-year-old children. Findings indicate a positive correlation between trait anger and systolic BP (SBP). Regression results indicate that the overall model significantly predicted SBP by explaining 15.4% of the variance and that trait anger was a significant predictor of SBP.

Tracking of blood pressure from childhood to adolescence in a Greek cohort

BACKGROUND

Studies have reported tracking of blood pressure (BP) from childhood to adulthood but with inconsistent results mainly due to methodological and ethnic differences. We aimed to examine BP tracking during a 7-year period in a Greek cohort.

METHODS

This is a longitudinal school-based study conducted during 1990-96 in Athens, Greece. Children underwent BP and anthropometric measurements on two to three visits annually (averaged to annual values) for 7 years.

RESULTS

A total of 166 children with complete yearly follow-up data for the examined period were included (mean baseline age 9 ± 1.7 years, range: 5-12 years, 89 boys). At baseline, the prevalence of pre- and hypertension was 22.9 and 24.1% respectively and at the end of the follow-up 24.1% (P = NS vs. baseline) and 13.3% (P = 0.02 vs. baseline) respectively. Systolic/diastolic BP tracking correlation coefficients between 1990 and 1996 were 0.38 (P < 0.001)/0.20 (P = 0.06) for boys and 0.30 (P = 0.007)/0.22 (P = 0.06) for girls. Among children with baseline BP ≥90th centile (systolic and/or diastolic), 44% remained in the same BP range after 7 years. In stepwise multiple regression analysis, baseline systolic BP, male gender, baseline body mass index (BMI) and change in BMI from baseline to the end of the follow-up (ΔBMI) were significant predictors of systolic BP levels at the end of the follow-up. Baseline diastolic BP, baseline BMI and ΔBMI were significant predictors of diastolic BP at the end of the follow-up.

CONCLUSIONS

These data suggest that the risk of developing high BP during adolescence can be predicted by BP and BMI at childhood.

Secular changes in anthropometric measurements and blood pressure in children of Crete, Greece, during 1992/93 and 2006/07

OBJECTIVES

To examine secular changes in anthropometric measurements and blood pressure (BP) in 1st-grade children in Crete, Greece, during 1992/93 and 2006/07.

METHODS

Children (aged 5.7-7.8 years) from two representative cross-sectional cohorts participated during 1992/93 (n=606) and 2006/07 (n=361). Body weight, body-mass-index (BMI), waist circumference (WC), waist-to-hip (WHpR) and waist-to-height (WHtR) ratios, BP, 20 m-shuttle-run test (20 mSRT), and moderate-to-vigorous-physical-activity (MVPA) were assessed.

RESULTS

There was a significant increase (P<0.01) in body weight (+10.2% and +6.7%), BMI (+6.9% and +4.0%), WC (+5.6% and +5.1%), WHpR (+3.0% and +3.4%), and WHtR (+4.2% and +3.8%), for boys and girls, respectively, and in the proportion of overweight/obese boys (19.4% vs. 33.7%; P<0.001) between 1992/93 and 2006/07. Both genders had decreased BP measurements in 2006/07 compared to 1992/93 (P<0.001). In both periods, BP was higher in obese compared to overweight and normal children (P<0.001), but there was no relationship between BP and physical activity (PA).

CONCLUSIONS

A substantial decrease in BP was observed in Cretan children over a 15-year period, despite a concurrent increase in obesity and anthropometric indices. This may be attributed to lifestyle and dietary changes and does not support the hypothesis that the obesity epidemic in children has resulted in proportionate increases in BP levels.

Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study

OBJECTIVE

To record the prevalence of overweight and obesity in urban primary-school children in relation to several socio-economic and demographic factors.

DESIGN

Cross-sectional.

SETTING/SUBJECTS

A representative sample of 729 schoolchildren (379 male and 350 female), aged 9-13 years, stratified by parental educational level, was examined in the urban region of Athens. Weight and height were measured using standard procedures. The International Obesity Task Force thresholds were used for the definition of overweight and obesity. Several socio-economic and demographic data and the child's 'popularity' score were also recorded with specifically designed standardized questionnaires.

RESULTS

The prevalence of overweight and obesity was 29·6 % and 11·1 %, respectively. Annual family income of € 12,000-20,000 (OR = 1·58), residence ownership (OR = 1·63) and the grandmother as the child's primary caregiver (OR = 1·38) were significantly associated with higher odds of childhood overweight and obesity. Non-Greek parental nationality (OR = 0·72) and higher 'popularity' scores of children (OR = 0·42) were significantly associated with lower odds of overweight and obesity. The grandmother as the child's primary caregiver and an annual family income of € 12,000-20,000 remained significantly associated with childhood overweight and obesity after adding all significant correlates of childhood overweight and obesity observed at the bivariate level in a multivariate regression model (OR = 1·51 and 1·61, respectively).

CONCLUSIONS

Among family income, residence ownership, child's primary caregiver, parental nationality and popularity scores that were identified as significant correlates of childhood overweight and obesity at the bivariate level, lower family income and grandmother as the child's primary caregiver were the only factors that remained significantly associated with childhood overweight and obesity at a multivariate level.

Obesity and associated cardiovascular risk factors among schoolchildren in Greece: a cross-sectional study and review of the literature

OBJECTIVE

To examine the prevalence and determinants of obesity and associated cardiovascular risk factors in a sample of Greek children.

METHODS

This is a cross-sectional, school-based study of 780 students (9.2 +/- 1.8 years old, 415 boys) conducted in Eastern Attica, the greater area of the city of Athens. The study protocol included anthropometric, blood pressure (BP), and biochemical measurements, as well as dietary and lifestyle habits assessment. A review of Greek studies on childhood obesity was also performed.

RESULTS

Approximately 22% of the participants were overweight and 8% were obese, which is in accordance with the results of 24 previous Greek studies showing the childhood overweight/obesity prevalence in the range of 30%. Overweight/obese children compared with normal-weight children had higher BP, lower high-density lipoprotein cholesterol (HDL-C), and higher triglycerides (p < 0.05 for all). Parental weight, consumption of sweets and fast-food, and decreased physical activity were independent determinants of being overweight/obese. Furthermore, overweight/obesity predicted the presence of high BP, low HDL-C, and high triglycerides.

CONCLUSION

A close association was revealed between obesity and metabolic abnormalities, underlining the need for early screening and intervention in overweight children in order to address the emerging childhood obesity epidemic in Greece.

Correlation between fat mass and blood pressure in healthy children

Obesity is a well-known risk factor for arterial hypertension. The aim of this study was to analyze which surrogate marker of adiposity, i.e., body mass index (BMI) or fat mass (FM), as measured by bioimpedance analysis (BIA), best correlated with blood pressure in healthy children. Body weight, height, and casual blood pressure (BP) were measured in 193 healthy children (103 boys), aged 8-16 years. Body composition was determined by BIA. The correlation between BMI and age was linear, whereas the correlation between percentage of FM and age was nonlinear and it was different in boys and girls. Blood pressure standard deviation scores (SDS) correlated with FM SDS (BIA) over the entire normal range (systolic: r = 0.26, p = 0.002; diastolic: r = 0.33, p < 0.01). An evaluation of the children based on BP (three groups: BP < 50th percentile, 50th < BP > 95th percentile; BP > 95th percentile) revealed that hypertensive children had a higher BMI (17.6 vs. 19.4 vs. 26.2 kg/m(2), respectively) and a greater FM (14.0 vs. 16.8 vs. 30.2%, respectively). In conclusion, the divergence in FM in healthy boys and girls can be determined by BIA but not by BMI. In healthy children, BP within the entire normal range correlated with FM, children with established hypertension presented with a significantly higher FM. The study points to FM as an important determinant of BP pressure in obese and non-obese children.

Trends in high blood pressure prevalence in Greek adolescents

A school-based screening with anthropometric and blood pressure (BP) measurements was performed in adolescents aged 12-17 years in the island of Samos, Greece, in 2004 and also in 2007. A total of 446 adolescents were included in the analysis in 2004 and 558 in 2007. The 2007 study population had higher levels of body mass index (BMI) (P<0.05) and systolic and diastolic BP (P<0.001), compared with 2004. The prevalence of high BP was 16.1% in 2004 and 22.9% in 2007 (P<0.01 for difference). Mean age-, sex- and BMI-adjusted BP increase was 4.1/10.5 mm Hg (systolic/diastolic). In multivariate analysis, BMI, male gender and age, but also modifiable factors (lack of physical activity, breakfast skipping, smoking and low milk consumption) were associated with increased BP levels in the study population. These data indicate that further to BMI, other factors such as adverse lifestyle and dietary habits appear to be associated with elevated BP levels in adolescents. Moreover, rising trends seem to characterize the prevalence of high BP.

Home and office blood pressure in children and adolescents: the role of obesity. The Arsakeion School Study

Obesity is related to office blood pressure (OBP). Important discrepancies exist between OBP and home blood pressure (HBP), providing complementary information for the management of hypertension. The association between obesity and HBP has not been investigated in children. The evidence on the role of obesity in the predominance of systolic blood pressure (SBP) over diastolic (DBP) in paediatric hypertension is limited. A total of 778 healthy subjects aged 6-18 years were recruited in this study. OBP and HBP were measured using electronic devices validated in children. Anthropometric measurements were measured and expressed as z-scores for height or age. Among all indices of obesity (z-scores), body mass index (BMI) showed the best association with BP. The effect of obesity (BMI) was more pronounced on: (i) SBP than DBP and (ii) H-SBP than O-SBP (O-SBP: r2=0.09, O-DBP: r2=0.05, H-SBP: r2=0.12, H-DBP: r2=0.06). The prevalence of systolic hypertension was higher than that of diastolic hypertension. This difference was significant only in office readings and independent from obesity (normal weight: 6.3% systolic hypertension versus 1.2% diastolic; obese: 37.9% versus 6.9%, P<0.05 for both). These data imply that in children and adolescents the z-score of BMI is the most appropriate index of the association between BP and obesity. It also suggests that obesity is probably more closely associated with home than office BP. Finally, although obesity appears to affect SBP more than DBP, these results suggest that the predominance of systolic hypertension in children and adolescents might not be only related to obesity but also to the measurement setting (office).

Parent-reported eating and leisure-time activity selection patterns related to energy balance in preschool- and school-aged children

OBJECTIVE

Compare parent-reported preschool- and school-aged children's eating and leisure-time activity patterns that are proposed to influence energy balance.

DESIGN

Cross-sectional investigation of children, 2 to 12 years, attending a well visit.

SETTING

Pediatric private practice/ambulatory pediatric clinic.

PARTICIPANTS

One hundred seventy-four children: 49% preschool-aged, 54% female, 28% Hispanic, and 34% overweight or at risk for overweight.

VARIABLES MEASURED

Parent-reported eating/leisure-time behaviors. Height/weight from medical records.

ANALYSIS

Analyses of covariance/chi-square tests; significance at P

RESULTS

By parents' report, preschool-aged children consumed more servings/day of low-fat dairy (2.1 +/- 1.6 vs 1.7 +/- 1.5; P < .01), fewer servings/day of sweetened drinks (1.4 +/- 1.9 vs 2.2 +/- 2.6; P < .01) and watched fewer hours/day of weekend TV (2.3 +/- 1. 3 vs 2.7 +/- 1.3; P < .05) than school-aged children. Fewer preschool-aged children consumed salty (14.0% vs 26.1%; P < .05) and sweet (16.3% vs. 29.5%; P < .05) snack food daily, and a greater percentage regularly consumed dinner with a parent (93.0% vs 80.7%; P < .05), as assessed by parent report.

CONCLUSIONS AND IMPLICATIONS

Parent-reported children's eating/leisure-time patterns that may influence energy balance were less healthful in the school-aged children. However, most children did not meet recommendations, irrespective of age or weight. Interventions for meeting recommendations should start with families with preschool-aged children. Future research should focus on identifying factors that might be contributing to increased reporting of problematic food and leisure-time activity patterns in school-aged children.

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Key Words

• children
• preschool
• diet
• leisure-time
• obesity

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MESH Headings

• Age Distribution
• Ambulatory Care Facilities
• Analysis of Variance
• Child
• Child, Preschool
• Cross-Sectional Studies
• Energy Intake/physiology
• Energy Metabolism/physiology
• Feeding Behavior/ethnology
• Feeding Behavior/physiology
• Feeding Behavior/psychology
• Female
• Humans
• Leisure Activities/psychology
• Male
• Overweight/etiology
• Parents
• Pediatrics
• Surveys and Questionnaires

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Grants

• R21 DK074919-01 NIDDK NIH HHS
• R21 DK074919-02 NIDDK NIH HHS
• R21 DK074919-03 NIDDK NIH HHS
• R21 DK074919 NIDDK NIH HHS
• DK074919 NIDDK NIH HHS

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Affiliation(s)

Hollie A Raynor Department of Nutrition, University of Tennessee, Knoxville, Tennessee 37996, USA.
Elissa Jelalian
Patrick M Vivier
Chantelle N Hart
Rena R Wing

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Lifestyle factors are determinants of children's blood pressure levels: the CYKIDS study

Elevated blood pressure (BP) levels represent an important risk factor for cardiovascular disease. Lifestyle factors associated with increased BP levels have been extensively investigated in adults, but not in children. Therefore, we aimed to explore associations among modifiable lifestyle and levels of BP in 10- to13-year-old children. A subsample of the CYKIDS (CYprus KIDS) national cross-sectional study consisting of 622 children (11.7+/-0.83 years) was used to evaluate the research hypothesis. Measurements included BP, height, weight and waist circumference. Body mass index (BMI) was calculated according to the International Obesity Task Force (IOTF) criteria. Adherence to the Mediterranean diet was assessed by the KIDMED (Mediterranean Diet Quality Index for children and adolescents) diet score, whereas physical activity was assessed through a physical activity index. Results have shown that the cutoff value of 120/80 mm Hg was significantly associated with various lifestyle indices. BMI was positively associated with systolic BP (SBP)>120 mm Hg (odds ratio (OR)=1.21, 95% confidence interval (CI) 1.11-1.32); diastolic BP (DBP)>80 mm Hg (OR=1.13, 95% CI 1.01-1.27) and SBP/DBP>120/80 mm Hg (OR=1.20, 95% CI 1.10-1.31). Moreover, children who reported that they frequently eat while watching television were about two times more likely to have elevated SBP or overall BP, whereas children with low socioeconomic status levels were more than 2.5 times more likely to have elevated BP levels. Finally, compared with those with low KIDMED score, children with at least an average [corrected] score were 75% less likely to have elevated DBP levels, whereas they exhibited a nonsignificant trend for lower SBP (by 29%) and lower overall BP levels (by 30%). Similar results emerged when the above analyses were repeated using the American reference values. Conclusively, our study suggests that lifestyle factors play an important role in determining BP levels in children; a finding that underlines the importance of lifestyle modifications in children.

Obesity in Mediterranean region (1997-2007): a systematic review

The objective of this review is to determine the distribution of obesity by geographical location, income, age and sex in the Mediterranean region during the last decade. A meta-analysis was conducted for 102 articles cited during the period (1997-2007) in Medline database (for 17 Mediterranean countries) searched during the summer of 2007 using the word 'obesity' and its related keywords. The study showed that adults were more obese than children in all Mediterranean continents and in different levels of income. The prevalence of obesity among European children was higher than among Asians. Also, European adults were more obese than European children. The total female adults were found to be more obese (median: 25.3%) than male adults (median: 20.0%). The regression model analysis indicated that male adults were more likely to be obese in the Euro-Med region. Taking different factors into consideration, it was noticed that Mediterranean adults, especially those in the European region, are at higher risk of obesity. Awareness programmes addressing the importance of adopting healthy dietary habits combined with physical activity should target the whole community in general and adults in particular. The findings could guide health planners for better management of obesity.

Television viewing and hypertension in obese children

BACKGROUND

Television viewing is strongly associated with an increased risk of childhood and adolescent obesity. However, the association between TV viewing and hypertension in children is unknown. This study aimed to identify whether TV watching is associated with hypertension in obese children.

METHODS

Children seen for obesity, aged 4 to 17 years, were evaluated at three pediatric centers from 2003 to 2005. In 2006-2007, a logistic regression model estimated the odds of hypertension for hours of daily TV time controlling for race, site, and body mass index (BMI) z-score.

RESULTS

A total of 546 subjects, with a mean age of 12 years, were evaluated. The children had a mean BMI of 35.5+/-9.3 kg/m(2) (98.7th+/-0.8 percentile, z-score 2.54+/-0.4). TV time was positively correlated with the severity of obesity. After controlling for race, site, and BMI z-score, both the severity of obesity and daily TV time were significant independent predictors of the presence of hypertension. Children watching 2 to 4 hours of TV had 2.5 times the odds of hypertension compared with children watching 0 to <2 hours. The odds of hypertension for children watching 4 or more hours of TV were 3.3 times greater than for children watching 0 to <2 hours of TV.

CONCLUSIONS

In obese children, the amount of time spent watching TV is associated with both hypertension and the severity of obesity. Thus, TV viewing is a potential target for addressing hypertension in obese children.

Association of blood pressure, obesity and serum homocysteine levels in healthy children

AIM

Obesity, hypertension and total serum homocysteine levels are well-known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children.

METHODS

Five hundred twenty-four healthy school children aged 6-15 years participated in the study. BMI were used to categorize our subjects in normal overweight and obese groups based on Internationally Obesity Task Force criteria.

RESULTS

The prevalence of overweight and obesity was 21.1% and 8.4% for boys and 17.6% and 7.3% for girls, respectively. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and waist circumference (WC) were significantly higher in overweight and obese group compared to normal ones, whereas for homocysteine levels no difference was observed. Based on the results derived from the multiple regression analysis, BMI was positively related to energy intake (beta=0.247, p<0.001) and WC (beta=0.014, p<0.001). Both SBP and DBP were positively related to age ([beta=0.251, p<0.001] and [beta=0.301, p<0.001, respectively]), and BMI ([beta=0.096, p<0.001] and [beta=0.022, p<0.001], respectively).

CONCLUSION

The current study revealed an association of blood pressure and WC with overweight and obesity in children, and even though these children may not have increased homocysteine levels, they still have enough reasons to reduce weight in order to avoid cardiovascular disease in their life later on.

Body fat is associated with blood pressure in school-aged girls with low cardiorespiratory fitness: The European Youth Heart Study

OBJECTIVE

To examine the association between anthropometric measurements of total and central adiposity and blood pressure in school-aged children, and to study whether these associations are modified by the levels of cardiorespiratory fitness.

METHODS

Systolic and diastolic blood pressure, weight, height, skinfold thickness and waist circumference were measured in 873 children aged 9-10 years participating in the Estonian and Swedish part of the European Youth Heart Study. Mean arterial pressure was calculated. Body mass index and skinfold thickness were used as markers of total adiposity, whereas waist circumference and waist-height ratio were used as markers of central adiposity. Cardiorespiratory fitness was estimated by a maximal ergometer bike test, and dichotomized into low and high levels.

RESULTS

Markers of total and central adiposity were positively associated with blood pressure. The results from the regression models showed that the markers of total and central adiposity were significantly associated with systolic blood pressure in girls with low levels of cardiorespiratory fitness. Similar results were observed when mean arterial pressure was the outcome variable. None of the markers of total and central adiposity were significantly associated with blood pressure in girls with high levels of cardiorespiratory fitness or in boys with low or high levels of cardiorespiratory fitness.

CONCLUSIONS

The results show a positive influence of simple anthropometric measurements of total and central adiposity on blood pressure, and suggest that higher cardiorespiratory fitness may attenuate the association between body fat and blood pressure in school-aged children.

Update on the metabolic syndrome in children

PURPOSE OF REVIEW

Provides an update on the metabolic syndrome in childhood.

RECENT FINDINGS

The metabolic syndrome is increasingly recognized among children. It is nearly exclusively encountered in overweight and obese individuals and is associated with atherosclerosis. Development and clustering of cardiovascular risk factors is influenced by many characteristics including heritable traits, prenatal and infantile influences, diet, physical activity, and socioeconomic status.

SUMMARY

Epidemiological data have become mature in this area. Efforts to design and implement systems to prevent and treat the metabolic syndrome are required.

Inaccuracy in pediatric outpatient blood pressure measurement

OBJECTIVE

Hypertension is common in the pediatric population. There is increasing evidence for early hypertensive target organ damage that may lead to substantial long-term morbidity. Because a critical aspect of any screening program for hypertension is the ability to measure blood pressure accurately, we compared typical blood pressure measurements at a vital sign station with those that were obtained following recommendations set forth in "The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents."

METHODS

We compared the blood pressure measurements that were obtained with standard practice vital sign station screening with those that were obtained by trained personnel in accordance with Fourth Task Force recommendations. A total of 390 children were evaluated at 580 visits to the Pediatric Hypertension Clinic at Texas Children's Hospital.

RESULTS

Seventy-four percent of the readings were higher at the vital sign station, and only 12% differed by <5 mm Hg for both systolic blood pressure and diastolic blood pressure. The mean difference between vital sign station and examination room was 13.2 +/- 8.9 mm Hg for systolic blood pressure and 9.6 +/- 7.6 mm Hg for diastolic blood pressure. Multiple regression analyses revealed that age, gender, race, obesity, first versus subsequent visit, essential versus secondary, or white coat hypertension and antihypertensive medications made no statistically significant difference in the lack of correlation of the readings.

CONCLUSION

These results suggest that if pediatricians use vital sign station screening for blood pressure, children with elevated initial measurements must be reevaluated in the examination room.