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

Breastfeeding moderates childhood obesity risk associated with prenatal exposure to excessive gestational weight gain

Gaining excessive gestational weight may increase obesity risk in the offspring, while breastfeeding lowers that risk. Using data from the Special Supplemental Nutrition Programme for Women, Infants and Children (WIC) in Southern California, we examined the associations between gestational weight gain (GWG), breastfeeding during infancy and childhood obesity at 2-4 years, and determined whether breastfeeding moderated the association between GWG and childhood obesity. GWG was based on weight measurements collected during the first trimester and within a month before delivery. GWG values were standardized by gestational age (GWG z-scores), per maternal prepregnancy body mass index (BMI) and categorized into tertiles. Fully breastfeeding duration was determined by WIC infant package data indicating the amount of infant formula received monthly. Children's length (or height) and weight measurements were used to calculate BMI-for-age z-scores and identify obesity (z-score ≥ 95th percentile). Multivariable linear and modified Poisson regression analyses were conducted. Fully breastfeeding moderated the association between GWG z-scores tertile and obesity in the offspring. Each additional month of fully breastfeeding was associated with 3%-5% obesity risk reduction for each age group and GWG z-scores tertile, except at age 4 years for children whose mothers had low GWG z-scores (tertile 1). Shorter fully breastfeeding duration was associated with greater obesity risk among children of mothers with high GWG z-scores (tertile 3), but not for those whose mothers had low GWG z-scores. Longer fully breastfeeding duration may provide greater protection against obesity among children at higher risk due to intrauterine exposure to high gestational weight gain.

Office blood pressure versus ambulatory blood pressure measurement in childhood obesity

BACKGROUND

The prevalence of obesity-related co-morbidities is rising parallel to the childhood obesity epidemic. High blood pressure (BP), as one of these co-morbidities, is detected nowadays at increasingly younger ages. The diagnosis of elevated BP and hypertension, especially in the childhood population, presents a challenge to clinicians. The added value of ambulatory blood pressure measurement (ABPM) in relation to office blood pressure (OBP) measurements in obese children is unclear. Furthermore, it is unknown how many overweight and obese children have an abnormal ABPM pattern. In this study we evaluated ABPM patterns in a population of overweight and obese children and adolescents, and compared these patterns with regular OBP measurements.

METHODS

In this cross-sectional study in overweight or obese children and adolescents aged 4-17 years who were referred to secondary pediatric obesity care in a large general hospital in The Netherlands, OBP was measured during a regular outpatient clinic visit. Additionally, all participants underwent a 24-hour ABPM on a regular week-day. Outcome measures were OBP, mean ambulatory SBP and DBP, BP load (percentage of readings above the ambulatory 95th blood pressure percentiles), ambulatory BP pattern (normal BP, white-coat hypertension, elevated BP, masked hypertension, ambulatory hypertension), and BP dipping.

RESULTS

We included 82 children aged 4-17 years. They had a mean BMI Z-score of 3.3 (standard deviation 0.6). Using ABPM, 54.9% of the children were normotensive (95% confidence interval 44.1-65.2), 26.8% had elevated BP, 9.8% ambulatory hypertension, 3.7% masked hypertension, and 4.9% white-coat hypertension. An isolated night-time BP load > 25% was detected in almost a quarter of the children. 40% of the participants lacked physiologic nocturnal systolic BP dipping. In the group of children with normal OBP, 22.2% turned out to have either elevated BP or masked hypertension on ABPM.

CONCLUSIONS

In this study a high prevalence of abnormal ABPM patterns in overweight or obese children and adolescents was detected. Additionally, OBP poorly correlated with the child's actual ABPM pattern. Herewith, we emphasized the usefulness of ABPM as an important diagnostic tool in this population.

Small for date preterm infants and risk of higher blood pressure in later life: A systematic review and meta-analysis

BACKGROUND

Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease.

OBJECTIVES

To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size.

METHODS

A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity.

RESULTS

We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I²  = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I²  = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains.

CONCLUSIONS

Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants.

Anthropometric indices, but not birth weight, are associated with high blood pressure risk among Malay adolescents in Kuala Lumpur

Background

With the high prevalence of hypertension, it is important to determine its predictors early. The aim of this study was to determine the association between blood pressure with anthropometric indices and birth weight among a population of Malay adolescents in Kuala Lumpur.

Design and methods

This cross-sectional study was carried out among 254 primary and secondary school adolescents aged 10 to 16 years. Anthropometric measurements and blood pressure were determined through standardized protocols, while participants' birth weight was obtained from birth certificate. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index (ABSI) were calculated.

Results

Boys had significantly higher weight, height, WC, WHtR and systolic blood pressure (SBP) than girls (p < 0.05). SBP was moderately correlated with body weight (r = 0.60), WC (r = 0.55), BMI (r = 0.54), height (r = 0.47), WHtR (rs = 0.36) and WHR (r = 0.30). Moderate correlations were found between diastolic blood pressure (DBP) with BMI (r = 0.26), WC (r = 0.23) and body weight (r = 0.20). Participants with BMI > +1SD had higher odds of being prehypertensive or hypertensive (aOR 8.97; 95% CI 3.16, 25.48), followed by participants with WC ≥ 90th percentile (aOR 6.31; 95% CI 2.48, 16.01) and participants with WHtR > 0.5 (aOR 5.10; 95% CI 2.05, 12.69). Multiple linear regression showed BMI was positively associated with both SBP and DBP. No significant association was found between birth weight and BP.

Conclusion

BMI had the best predictive ability for SBP and DBP. These findings strongly emphasize the importance of primary prevention of hypertension in adolescents, especially among those with high BMI.

Investigating the prevalence of hypertension and its associated risk factors in a population-based study: Fasa PERSIAN COHORT data

Background

A high prevalence rate of hypertension (HTN) and its subsequent serious complications made this disease a major health-treatment concern in many societies. The current study aimed to investigate the prevalence of hypertension and its associated risk factors in Fasa PERSIAN COHORT in south of Iran in 2019.

Methods

This was an analytical-cross sectional study. The study population were the individuals covered by Fasa cohort. Information of the first phase of Fasa Persian cohort in south of Iran was used in this study. Independent t test, chi-square test, analysis of variances, Pearson correlation coefficient, and multiple stepwise regression were used to analyze the obtained data. Thereafter, the data was analyzed using SPSS software version 22, and P value < 0.05 was considered as statistically significant.

Results

Out of 10,111 individuals included in the study, 5546 (54.86%) subjects were women and 4565 (45.16%) other were men. The overall prevalence rate of hypertension was estimated as 46.6%. In the present study, (16/1%) of the participants were with HTN stage 1, and (17/9%) of them were with HTN stage 2. The results show that there were significant positive correlations among HTN and age, BMI, HDL, TG, BUN, ALP, smoking, physical activity, cardiovascular diseases, diabetes, and renal failure (P < 0.5).

Conclusions

Prevalence of HTN in this study population is considerable. Therefore, it is suggested that health system should program some plans to prevent hypertension’s prevalence and eliminate its risk factors.

Pet ownership in utero and in childhood decreases the effects of environmental tobacco smoke exposure on hypertension in children: A large population based cohort study

BACKGROUND

Little is known about whether exposure to pets influences the association between hypertension and environmental tobacco smoke (ETS). The current study aims to examine the interaction of pet ownership on ETS exposure and the development of hypertension in children.

METHODS

From 2012 to 2013, a total of 9354 children, 5 to 17 years of age, were recruited from 62 schools in seven northeastern cities. BP in children was measured and hypertension was defined as an average diastolic blood pressure (DBP) or systolic blood pressure (SBP) at or above the 95th percentile for that child's age, sex, and height. Pet ownership in three different time periods (in utero, past 2 years, and currently) and ETS exposure data were collected from parents via a questionnaire. Two-level regressions were used for the data analyses.

RESULTS

The data show consistent, significant interactions between exposure to pets and effects from ETS. Children who were not exposed to pets experienced stronger effects from ETS on hypertension when compared to those exposed to pets, and the protective effect of pet ownership became stronger with a greater number of pets in the home. Exposure to in utero ETS was associated with hypertension [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI): 1.13-1.54] only for those children without pet exposure in utero but not for those with pets (aOR = 0.75; 95% CI: 0.49-1.15) (p_interaction < 0.05). Moreover, household dog ownership was related to significantly lower effects of current ETS on hypertension (aOR = 0.80, 95% CI: 0.61-1.05) compared with children without dogs (aOR = 1.26, 95% CI: 1.11-1.44) (p_interaction = 0.001). Interaction associations between ETS and pet ownership were more robust for girls than for boys and for younger than older children.

CONCLUSION

This study indicates an inverse relationship between pet ownership and ETS, potentially pointing to pet ownership as protecting against the development of hypertension in children.

Prenatal Alcohol Exposure and the Associated Risk of Elevated Blood Pressure: A Cross-sectional Analysis of 3- to 17-Year-Olds in Germany

BACKGROUND

As the prevalence of obesity and high blood pressure increases among the population, early action is needed to reduce blood pressure. Certain lifestyles during pregnancy have negative effects resulting in high blood pressure for children and adolescents. Using data from the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS), this study analyzed: (i) the association between low-to-moderate prenatal alcohol exposure (PAE) and the risk of increased systolic and diastolic blood pressure and (ii) whether associations were modified by socioeconomic status (SES), prenatal smoke exposure (PSE), and body mass index (BMI) of the children and adolescents.

METHODS

We applied multivariate logistic regression analyses and stratified analyses by SES, PSE, and BMI with cross-sectional data from the KiGGS study (N = 14,253) to examine the association between PAE and prehypertension or hypertension in 3- to 17-year-olds.

RESULTS

Of the surveyed children and adolescents, 13.7% had a systolic prehypertension and 11.5% had a diastolic prehypertension. A further 7.5% were identified as having systolic hypertension and 6.0% diastolic hypertension. In the regression analyses, PAE resulted in a decreased risk of systolic prehypertension (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.70, 0.99) and diastolic prehypertension (OR: 0.82, 95% CI: 0.68, 0.98). Risk reductions were not significant in surveyed children and adolescents with hypertension. Interactions between PAE and SES, PSE, and offspring BMI were not significant.

CONCLUSIONS

Contrary to our initial hypothesis, PAE reduces the risk of prehypertension. Animal studies suggest that vasodilation is induced by nitric oxide in small quantities of PAE.

Multifactorial correlates of blood pressure in South Asian children in Canada: a cross-sectional study

OBJECTIVE

We sought to explore various correlates of blood pressure (BP) and hypertension, and to identify the most important aggregate combination of correlates for BP in South Asian children.

DESIGN

Cross-sectional study SETTING: Community-based recruitment in two Canadian cities PARTICIPANTS: South Asian children (n=762) provided a range of physiological, lifestyle and social variables. BP was assessed using an automated device. Body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and BP were transformed to z-scores using published standards.

OUTCOME MEASURES

Linear and logistic regression analyses were used to explore associations between the range of variables with BP z-scores and hypertension while stepwise regression was used to identify aggregate factors that provided explanatory capacity for systolic BP (SBP) and diastolic BP (DBP) z-scores.

RESULTS

A range of variables were associated with BP z-score and hypertension in unadjusted analysis. On adjustment for confounders, the association between age (β=-0.054, 95% CI=-0.078 to 0.029), female sex (β=-0.208, 95% CI=-0.350 to -0.067), height (β=0.022, 95% CI=0.011 to 0.033), weight (β=0.047, 95% CI=0.040 to 0.055), BMI z-score (β=0.292, 95% CI=0.249 to 0.336), WC z-score (β=0.273, 95% CI=0.219 to 0.326), WHtR z-score (β=0.289, 95% CI=0.236 to 0.342), heart rate (β=0.016, 95% CI=0.010 to 0.022), child's perception of body image (β=0.183, 95% CI=0.128 to 0.239) and grip strength (β=0.025, 95% CI=0.007 to 0.043) with SBP z-score remained. In stepwise regression, age, sex, BMI z-score, heart rate and weight accounted for 30% of the variance of SBP z-score, while age, BMI z-score, heart rate and daily fast food intake accounted for 23% of the DBP z-score variance.

CONCLUSION

Our findings suggest that variables, such as age, sex, height, adiposity and heart rate, provide stronger explanatory capacity to BP variance and hypertension risk than other variables in South Asian children.

Chia Seed (Salvia hispanica L.) as a Source of Proteins and Bioactive Peptides with Health Benefits: A Review

The consumption of chia seed (Salvia hispanica L.) has increased in recent years due its high content of omega-3 fatty acids and dietary fiber. This seed also has a high concentration of proteins and essential amino acids, becoming a promising source of bioactive peptides. The objective of this review was to identify the composition and the beneficial effects of chia seeds (S. hispanica L.), their proteins, peptides, and their potential impact on human health. The UniProt database was used to identify the chia proteins and their amino acid sequences. The BIOPEP database was used to analyze the peptides's bioactive potential. A total of 20 proteins were cataloged in chia seed, 12 of those were involved in the regular metabolic processes of the plant cells. However, eight proteins were specifically related to production and storage of plant lipids, thus explaining the high concentration of lipids in chia seeds (around 30%), especially omega-3 fatty acids (around 20%). The analyses of amino acid sequences showed peptides with bioactive potential, including dipeptidyl peptidase-IV inhibitors, angiotensin-converting enzyme inhibitors, and antioxidant capacity. These results correlated with the main health benefits of whole chia seed in humans such as antioxidant capacity, and hypotensive, hypoglycemic, and anticholesterolemic effects. Such relation can be associated with chia protein and peptide compositions and therefore needs further investigation in vitro and in vivo.