Body mass index trajectory from childhood to puberty and high blood pressure: the China Health and Nutrition Survey

Interplay of Weight Status and Sleep Autonomic Function in Mediating and Moderating the Link Between Disease Severity and Blood Pressure in Paediatric Obstructive Sleep Apnoea

INTRODUCTION

Obstructive sleep apnoea (OSA) in children is associated with numerous adverse outcomes, including elevated blood pressure. While the associations between OSA, obesity, and autonomic dysfunction are recognised, the precise mechanisms linking these factors and their relationship with elevated blood pressure in children remain unclear.

METHODS

This retrospective case series included 76 children with OSA. The relationships between night-time systolic and diastolic blood pressures, body mass index, and clinical, polysomnographic, and sleep heart rate variability variables were investigated. Mediation and moderation analyses were performed.

RESULTS

Correlation analyses revealed significant associations between both systolic and diastolic blood pressures with body mass index, age, sex, adenoidal-nasopharyngeal ratio, apnoea-hypopnoea index, and sleep low frequency/high frequency (LF/HF) ratio. In multivariable linear regression models, body mass index, adenoidal-nasopharyngeal ratio, and LF/HF ratio were independently associated with systolic blood pressure, while body mass index and adenoidal-nasopharyngeal ratio were independently associated with diastolic blood pressure. Mediation and moderation analyses identified a conceptual mediation with a moderated direct path model in which body mass index mediated, and the LF/HF ratio moderated, the relationship between apnoea-hypopnoea index and systolic blood pressure. Additionally, children with concomitant OSA and attention deficit hyperactivity disorder had a significantly higher LF/HF ratio than those with OSA alone.

CONCLUSION

In children with OSA, the relationship between apnoea-hypopnoea index and systolic blood pressure was mediated by weight status and modulated by sleep sympathovagal balance. Children with OSA and attention deficit hyperactivity disorder exhibited greater disturbances in sympathovagal balance. Further research is warranted to explore these associations.

BMI trajectories from birth to young adulthood associate with distinct cardiometabolic profiles

BACKGROUND

Numerous studies have investigated links between body mass index (BMI) trajectories and cardiovascular risk, yet discrepancies in BMI measurement duration and timing of the cardiovascular-related outcome evaluation have led to inconsistent findings.

METHODS

We included participants from the Swedish birth cohort (BAMSE) and applied latent class mixture modeling to identify BMI trajectories using data of multiple BMI measures (≥ 4 times) from birth until 24-year follow-up (n = 3204). Subsequently, we analyzed the associations of BMI trajectories with lipids (n = 1974), blood pressure (n = 2022), HbA1c (n = 941), and blood leukocytes (n = 1973) using linear regression. We also investigated the circulating levels of 92 inflammation-related proteins (n = 1866) across BMI trajectories.

RESULTS

Six distinct BMI groups were identified, denoted as increasing-persistent high (n = 74; 2.3%), high-accelerated increasing (n = 209; 6.5%), increasing-accelerated resolving (n = 142; 4.4%), normal-above normal (n = 721; 22.5%), stable normal (n = 1608; 50.2%), and decreasing-persistent low (n = 450; 14.1%) BMI groups. The increasing-persistent high and high-accelerated increasing BMI groups had higher levels of total cholesterol [mean difference (95% confidence intervals): 0.30 (0.04-0.56) and 0.16 (0.02-0.31) mmol/L], triglyceride, low-density lipoprotein, hemoglobin A1C [3.61 (2.17-5.54) and 1.18 (0.40-1.98) mmol/mol], and low-density lipoprotein/high-density lipoprotein ratios, but a lower level of high-density lipoprotein than the stable normal BMI group. These two groups also had higher leukocyte cell counts and higher circulating levels of 28 inflammation-related proteins. No increased cardiometabolic markers were observed in the increasing-accelerated resolving BMI group.

CONCLUSIONS

Participants with persistently high or accelerated increasing BMI trajectories from birth to young adulthood have elevated levels of cardiometabolic risk markers at young adulthood than those with stable normal BMI. However, a raised BMI in childhood may not be inherently harmful to cardiometabolic health, provided it does not persist into adulthood.

Sex-specific associations between body mass index trajectories and risk of hypertension

BACKGROUND

Although it is well established that obesity is a risk factor for hypertension, the effect of distinct long-term patterns of body mass index (BMI) on blood pressure (BP) in later life is poorly understood.

METHODS

Based on the China Health and Nutrition Survey, we analyzed 2920 participants aged 3-17 years with initial normal BP at baseline (1991-2011), who were followed up for the development of hypertension (1993-2015). The group-based trajectory model was applied to identify BMI trajectories, and Cox regression was used to assess their associations with hypertension risk. Stratified analyses were conducted to explore differences across subgroups.

RESULTS

During an average follow-up time of 11.20 (7.69) years for males and 7.20 (5.21) years for females, 339 males and 212 females were identified with hypertension, respectively. Three BMI trajectories were identified: low-increasing (60.58% of males and 73.03% of females), moderate-increasing (33.08% of males and 24.22% of females), and high-increasing (6.34% of males and 2.76% of females). Our study found a significant positive association between a higher BMI trajectory and hypertension risk in males (all P for trend < 0.05). Specifically, males in the high-increasing BMI group had a higher risk of hypertension compared with those in the low-increasing group (HR = 1.76, 95% CI: 1.04-2.97). Stratified analyses revealed stronger associations among smokers, drinkers, and inactive individuals.

CONCLUSION

Our findings suggest that maintaining a normal BMI and healthy lifestyle from childhood may lower subsequent risk of hypertension.

Effect of body mass index trajectory on hypertension among children and adolescents aged 5-18 years: a retrospective cohort study

BACKGROUND

Hypertension has become increasingly prevalent in Chinese children and adolescents in recent decades, which affects growth and development of children, leads to cognitive decline and multiple target organ damage. Here, we assessed the impact of different body mass index (BMI) trajectories on the occurrence of hypertension in children and adolescents using a cohort study in Northeast China.

MATERIALS AND METHODS

Children and adolescents aged 5-18 years was extracted for physical examination in Fuxin City, Liaoning Province, China during the 2009-2015 period. A latent category growth mixed model (LCGMM) was used to classify BMI changes and analyze the effect of different BMI trajectories on the risk of occurrence of hypertension in these participants within 5 years.

RESULTS

All participates were divided into five BMI trajectories by LCGMM method: slow increasing group (n = 2616, 30.8%), overweight and obesity (OW/OB) group (n = 1141, 13.4%), normal decreasing group (n = 232, 2.7%), stable normal group (n = 4383, 51.6%), and fast-increasing group (n = 120, 1.4%). Compared with the stable normal group, the slow increasing group [adjusted odds ratio (AOR): 1.610, 95% confidence interval (CI): 1.304-1.989], the OW/OB group (AOR: 3.172, 95% CI: 2.500-4.023) and the fast-increasing group (AOR: 2.708, 95% CI: 1.445-5.074) all increased the risk of developing hypertension in children and adolescents.

CONCLUSION

The potential of developing hypertension varies among groups of children aged 5-18 with different BMI trajectories. Children and adolescents in the normal BMI range (the slow growth group) still need to be aware of the change in BMI trajectory to stop or slow down the progression of BP abnormalities.

Latent Classes of Anthropometric Growth in Early Childhood Using Uni- and Multivariate approaches in a South African Birth Cohort

Background

Conventional methods for modelling longitudinal growth data focus on the analysis of mean longitudinal trends or the identification of abnormal growth based on cross-sectional standardized z-scores. Latent Class Mixed Modelling (LCMM) considers the underlying heterogeneity in growth profiles and allows for the identification of groups of subjects that follow similar longitudinal trends.

Methods

LCMM was used to identify underlying latent profiles of growth for univariate responses of standardized height, standardized weight, standardized body mass index and standardized weight-for-length/height measurements and multivariate response of joint standardized height and standardized weight measurements from birth to five years for a sample of 1143 children from a South African birth cohort, the Drakenstein Child Health Study (DCHS). Allocations across latent growth classes were compared to better understand the differences and similarities across the classes identified given different composite measures of height and weight as input.

Results

Four classes of growth within standardized height (n1=516, n2=112, n3=187, n4=321) and standardized weight (n1=263, n2=150, n3=584, n4=142), three latent growth classes within Body Mass Index (BMI) (n1=481, n2=485, n3=149) and Weight for length/height (WFH) (n1=321, n2=710, n3=84) and five latent growth classes within the multivariate response of standardized height and standardized weight (n1=318, n2=205, n3=75, n4=296, n5=242) were identified, each with distinct trajectories over childhood. A strong association was found between various growth classes and abnormal growth features such as rapid weight gain, stunting, underweight and overweight.

Conclusions

With the identification of these classes, a better understanding of distinct childhood growth trajectories and their predictors may be gained, informing interventions to promote optimal childhood growth.

Association of body mass index trajectory and hypertension risk: A systematic review of cohort studies and network meta-analysis of 89,094 participants

Introduction

Body mass index (BMI) trajectories, such as non-linear time trends and nonlinear changes in BMI with age, can provide information on the underlying temporal health patterns. The relationship between BMI trajectories and the risk of hypertension remains controversial.

Methods

PubMed, Embase, Cochrane, Scopus, and Web of Science databases were searched from their inception to January 31, 2022. We categorized BMI trajectories as "Stable high," "table normal," "Stable low," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)." The main outcome was the relative risk for the prevalence of hypertension in the different BMI trajectories. Potential sources of heterogeneity were examined using meta-regression and subgroup analysis. A publication bias test and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were also used.

Results

The 18 cohort studies included 89,094 participants. Compared with the "Stable normal" trajectory, "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension: [RR (95% CI)]: 1.80 (1.29 2.50), p < 0.001; 1.53 (1.27 1.83), p < 0.001; 1.30 (1.24 1.37), p = 0.001, respectively. The "Stable low" trajectory was associated with a reduced risk of hypertension [0.83 (0.79 0.83), p < 0.001]. The "Stable high" trajectory (surface under the cumulative ranking curve = 88.1%) had the highest probability of developing hypertension in the population. The certainty of the evidence for direct comparisons of the incidence of hypertension between various BMI trajectories was generally very low.

Conclusion

Our findings suggested that "Stable high," "Fluctuated (sharp increase)," and "Fluctuated (elevated-decrease)" trajectories were associated with an increased relative risk of hypertension, with the "Stable high" trajectory most likely associated with hypertension.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=308575], identifier [CRD42022308575].

The associations between problematic smartphone use and blood pressure among 2,573 aged 9-17 years students in Shanghai, China

Objectives

This study aimed to (1) examine the cross-sectional association between problematic smartphone use (PSU) and blood pressure (BP) in children and adolescents and (2) determine whether the association between PSU and BP differs by the grade of students.

Methods

We recruited a total of 2,573 participants from 14 schools in Shanghai by a two-stage sampling method. We derived BP data from the participant's most recent medical examination data, including systolic blood pressure (SBP) and diastolic blood pressure (DBP). We measured PSU by a modified PSU Classification Scale. We also assessed demographic characteristics, body mass index, behavioral variables, and physiological characteristics.

Results

High school students had higher BP and PSU scores than primary and middle school students. PSU on the dimension of information collection was associated positively with both SBP and DBP among primary and middle school students, with the β (95% CI) values of 0.282 (0.018, 0.546) and 0.229 (0.031, 0.427). Meanwhile, the dimension of the relationship of social network was associated positively with SBP among primary and middle school students, with a β (95% CI) value of 0.390 (0.062, 0.717). PSU on the dimension of information collection was positively associated with the development of high BP, with a OR (95% CI) value of 1.072 (1.011, 1.137) among primary and middle school students.

Conclusions

PSU might be a potential correlate of high BP among school-age children and adolescents. The associations between PSU and BP differed by the grade of students as well as according to the four dimensions of PSU.