Blood pressure and associated factors in a North African adolescent population. a national cross-sectional study in Tunisia

Prevalence of Prehypertension, Hypertension, and its Determinants Among Young Adults in Enugu State, Nigeria

Background

Emerging epidemiological data suggest that Hypertension (HTN) has become a significant public health challenge in sub-Saharan Africa. HTN in young adults is a problem lacking relevant attention because it is still erroneously considered a disease of the old. This study aimed to determine the prevalence of hypertension and its associated risk factors in undergraduate medical students at the University of Nigeria, Enugu Campus, Enugu State, Nigeria.

Methodology

This was a cross-sectional study conducted between March and April 2021. This study recruited 279 consenting medical students (136 males and 143 females) aged 18-35 years. They were administered with a structured questionnaire. Data on sociodemographic information and risk factors for hypertension were collected. Blood pressure, waist circumference, weight, height, and body mass index were measured using standard methods. All data collected were carried out following the Institutional ethical guidelines and that of the Helsinki as revised in 2000. Data were analyzed using IBM Statistical Package for Social Sciences version 25, and statistical tools employed include descriptive statistics and Chi tests. Results were recorded as mean standard deviation, and statistical significance was taken at p<0.05.

Results

This present study has shown a prevalence rate of 19.93% for hypertension. Isolated diastolic hypertension constituted a greater burden with a prevalence of 13.65% than systolic Hypertension (0.74%) and systolic-diastolic Hypertension 5.4%. The prevalence of prehypertension was 48.7%, with a higher incidence observed in females (25.8%), individuals aged 21-25 years (26.4), and those with normal BMI (35.1%). A significant association was observed between the stage of hypertension and gender (p = 0.005), and age category (p = 0.037). Of the examined cohort, 7.75% were underweight, 16.5% overweight, and 2.2% obese. Notably, systolic, and diastolic blood pressure, weight, as well as waist circumference showed significant (p = 0.01, p = 0.007, p =0.01 and p<0.0001 respectively) increases concomitant with advancing age.

Conclusion

There is an increased prevalence of prehypertension and hypertension among young adults. This calls for a comprehensive national screening, public enlightenment, and targeted prevention programs that foster healthy lifestyle behaviours, physical activity, and healthy eating among students.

Association of some biochemical parameters and blood pressure among males with hypertension in the camps of Nineveh province-Iraq

BACKGROUND

Hypertension is a significant public health problem that affects people all over the world. Various epidemiologic researches have been conducted to reveal the relationship between hypertension and several biochemical markers. The goal of this project was to investigate the electrolytes, glucose, total protein, and lipid profile in people with normal and high blood pressure.

MATERIALS AND METHODS

Between 2020 and 2022, a case-control study was done. Two hundred and eighteen males, age ranging from 30 to 70, took part in the study. The conventional flame photometric method was used to evaluate serum electrolytes, whereas kits from Biolab Company's kits were used to quantify serum calcium, serum glucose, and lipid profile.

RESULTS

When compared to normotension males, hypertension males had considerably greater salt, chloride, and potassium levels in their blood, but no significant variations in calcium levels. When compared to normotension males, hypertension individuals had considerably higher mean glucose, total cholesterol, low, and high-density lipoprotein cholesterol, and triglycerides. Many amino acids were identified in the blood of male hypertension patients, consisting of leucine, aspartic acid, glutamic acid, asparagine, serine, histidine, glycine, arginine, alanine, methionine, valine, and phenylalanine.

CONCLUSIONS

In this group, hypertension males have a different lipid and electrolyte profile than normotensive males.

Patterns and predictors of elevated blood pressure and hypertension among primary school children in urban Kenya

OBJECTIVE

We examined the prevalence of elevated blood pressure (BP) and hypertension among 390 primary school children of different socioeconomic status (SES) in two urban settings in Kenya and explored the association between children's BP status and their sociodemographic characteristics, dietary behaviours and overweight/obesity status.

METHODS

Children's BP and anthropometric measurements were taken and parents, with the help of their children, completed questionnaires on the children's dietary behaviours. An average of three BP readings was used to calculate BP percentiles by age, sex and height. BMI-for-age z-scores, waist-circumference-to-height ratio and the sum of skinfold measures were calculated. We utilized prevalence ratio analysis to examine the association between BP and sociodemographic characteristics, dietary behaviours and overweight/obesity.

RESULTS

About 9% of the school children had elevated BP and 33% had stage 1 hypertension. Among overweight children, the proportion of children with elevated BP was 1.85-fold greater and the proportion of children with hypertension was 1.83-fold greater compared with children with healthy body weight. Similar patterns of significant associations were seen among obese children, children with central obesity and children with high total skinfold values. The proportion of children with hypertension was 1.42-fold greater among children with high frequency of consumption of chips/crisps compared with children with lower frequency of consumption.

CONCLUSION

These results increase our understanding BP patterns and determinants among school children in Kenya and can help inform noncommunicable disease prevention efforts.

Systematic review and meta-analysis: Prevalence of hypertension among adolescents in the Arab countries

PROBLEM

Hypertension (HTN) is one of the non-communicable diseases which prevalence is rising in both developed and developing countries. There is a scarcity of data on the prevalence of HTN in Arab countries. This review outlines what is currently known about prevalence and risk factors of HTN in adolescence in Arab world.

ELIGIBILITY CRITERIA

A systematic review and meta-analysis were conducted using PubMed, Cochrane Library, Scopus, CINAHL, Science Direct, and Google Scholar databases from 2011 to 2021.

SAMPLE

Fourteen studies from 9 Arab countries met inclusion criteria. Studies included a total of 777 adolescents with HTN and 2147 adolescents with pre-HTN.

RESULTS

The overall prevalence of HTN among adolescents in the Arab World was estimated at 12.6% (95CI 0.083-0.176), while pre-HTN was 13.9% (95CI 0.084-0205). Overweight and obesity resemble the higher risk of developing hypertension. Family history, high consumption of salt, smoking and low physical activity also increase the risk of HTN. The development of adolescent HTN can be predicted through anthropometric measurements such as Body Mass Index (BMI), wrist circumferences, and high waist circumference.

CONCLUSION

The prevalence of HTN among adolescents in the Arab world was significant, ranging from 4 to 26%. The heterogeneity between studies was high.

IMPLICATION

Local governments and policymakers must consider strengthening regulations to address environmental risk factors and improve public awareness about risk factors to HTN. A combined use of nurse- and patient targeted educational interventions could also help in reducing the burden of HTN in this population.

Plantain based dough meal: nutritional property, antioxidant activity and dyslipidemia ameliorating potential in high-fat induced rats

Background

Dyslipidemia is an aberrant rise in blood lipids due to diet and lifestyle. It has implicated as the major risk factor for developing hypertension among other diseases. This study was designed to evaluate plantain based dough meal nutritional property, antioxidant activity and dyslipidemia ameliorating potential in high-fat induced rats.

Methods

The flour blends, i.e., PSC (Plantain 70%, Soycake 30%), PSR (Plantain 65%, Soycake 30%, Rice-bran 5%), PSO (Plantain 65%, Soycake 30%, Oat-bran 5%), PSRO (Plantain 60%, Soycake 30%, Rice-bran 5%, Oat-bran 5%) and controls (100% Plantain flour & Cerolina) were evaluated for chemical, antioxidants and antihyperlipidemia.

Results

Protein, fiber and energy composition varied from 2.2–4.97 g/100 g, 16.44–19.59 g/100 g and 369.7–385.5 kcal/100 g, respectively. Essential amino acid index and predicted-biological values of the foods ranged from 68.31–76.31% and 62.19–71.48%, respectively. Phenolic profiles (mg/g) were gallic acid (25.33–31.26), caffeic acid (2.75–4.61), ferulic acid (5.16–12.73), luteolin (16.31–23.60), kaempferol (21.51–30.64), quercetin (24.28–37.13), chlorogenic acid (42.25–59.78), myricetin (28.41–38.41), 3,5-dicaffeoylquinic acid (27.17–41.59) and 4, 5-dicaffeoylquinic acid (39.96–51.28). The antioxidant activity of PSRO on ABTS, DPPH, FRAP, Fe2+ chelation and OH free radicals was higher than other foods. Atherogenic index, coronary risk index and log (TG/HDL-conc.) of rats fed on experimental foods were lower than recommended values.

Conclusion

The study established that PSRO had higher antioxidant and anti-hyperlipidemia properties; hence, it may be suitable as a functional food.

Association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents

Background

Determining high blood pressure in childhood is an important step to reduce the risk of occurrence of high blood pressure-related diseases in adulthood.

Aims

This study aimed to assess the association of blood pressure with dietary intake, physical activity, and anthropometric measurements in Turkish adolescents.

Patients and Methods

This cross-sectional study included 370 students (202 females, 168 males) aged 14 to 18 years from one private and one public school in Kayseri, Turkey. Some anthropometric measurements and 24-hour dietary recall of the students were obtained. Their blood pressures were measured, and the International Physical Activity Questionnaire and the Mediterranean Diet Quality Index (KIDMED) were used.

Results

The body mass index (BMI) mean and waist/height ratio of the hypertensive group were significantly higher than those of the prehypertensive group, whereas their daily potassium, calcium, and magnesium intakes were significantly lower than those of the normotensive group. The percentage of individuals with very low diet quality was higher in the hypertensive group than in the normotensive group (P > 0.05). The percentage of participants with sufficient physical activity was higher in the normotensive group than in the prehypertensive and hypertensive groups.

Conclusion

Factors such as high BMI and waist/height rates; low calcium, magnesium, and potassium intakes with diet; insufficient physical activity; and low quality of diet might cause an increase in the blood pressure.

Prevalence of Hypertension and Adherence to Dietary Approaches to Stop Hypertension Diet Score in Childbearing Age Tunisian Women: A Cross-Sectional Study

Background and Aims

The prevalence, awareness, and treatment of hypertension, along with their sociodemographic, anthropometric, and lifestyle associations, were evaluated in a cross-sectional survey of childbearing age Tunisian women. Adherence to the Dietary Approaches to Stop Hypertension diet score was also assessed for hypertensive versus nonhypertensive women.

Methods and Results

A total of 1689 nonpregnant women, aged 20-49 years, were randomly sampled a regional (Greater Tunis), two-stage, stratified, cross-sectional cluster survey from March 2009 to January 2010. Data on medical history and sociodemographic characteristics were collected using a questionnaire. The average daily intake of energy and nutrients was computed using a specific Tunisian food composition database. The Dietary Approaches to Stop Hypertension diet score (0 to 10) was assessed by adding the individual scores (0 to 1) of ten nutrient components according to dietary guidelines. The overall prevalence of hypertension was 21.4%. Age, obesity, abdominal fat, parity, and family history were significantly associated with hypertension. The mean Dietary Approaches to Stop Hypertension accordance score was 4.93 for hypertensive women and 4.86 for nonhypertensive women (P = 0.0556). After adjustment for age, energy intake, and all nutritional covariates, no associations were observed between hypertension and Dietary Approaches to Stop Hypertension diet components.

Conclusion

Though no clear-cut associations between hypertension and environmental or behavioral factors were identified in the study, the association with abdominal obesity and multiparity suggests that interventions aimed at lifestyle modifications to reduce these risk factors could be also useful in the prevention of hypertension.

Food Consumption Patterns and Nutrient Intakes of Children and Adolescents in the Eastern Mediterranean Region: A Call for Policy Action

The Eastern Mediterranean Region (EMR) has witnessed significant social and economic changes that may have influenced the diet of children and adolescents, and increased the risk for obesity and malnutrition in this age group. This review aims to characterize and assess food consumption patterns and nutrient intakes amongst school-aged children (5-10 years) and adolescents (10-19 years) in countries of the EMR. Electronic databases (MedLine, PubMed, Scopus, and Google Scholar) were searched for relevant articles published between 2005 and 2020; international organizations and governmental websites were also searched. Available studies documented low intakes of fruits, vegetables and fiber, inadequate consumption of water, milk and dairy products, coupled with high intakes of fat, saturated fat, and sugar sweetened beverages, as well as a frequent consumption of energy-dense, nutrient poor foods such as sweet and savory snacks. Micronutrient inadequacies were also observed, particularly for calcium, iron, zinc and vitamins A, D, C, and folate. Acknowledging the impact that nutrition may have on building societies and transforming the lives of children, adolescents and their families, there is a crucial need for a food system approach in developing and implementing national and regional policies and interventions aimed at improving the diet of children and adolescents.

Are Body Composition Parameters Better than Conventional Anthropometric Measures in Predicting Pediatric Hypertension?

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.

Cardio-metabolic risk factors in Tunisia: state of the art

Cardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. It is resulting from a new phase of epidemiological transition characterised by ageing and an increase in non-communicable diseases. It is common in both genders with some disparities between urban and rural regions, educational levels and social classes. Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall cardiometabolic risk factors.

A Non-Invasive Investigation into the Prevalence of Higher than Normal Blood Pressure, Hypertension and the Association between Blood Pressure and Body Weight in Male and Female Adolescents in the Polokwane Local Municipality, Limpopo-South Africa: A Cross-Sectional Study

BACKGROUND

Hypertension (HT) is one of the greatest non-communicable diseases affecting both sexes in all human populations; and it is a major cause of death and morbidity across the world. The purpose of this study was to investigate the prevalence of pre-hypertension, hypertension and investigate the association between blood pressure (BP) and body weight (looking into body mass index (BMI) and body surface area (BSA)).

METHOD

A cross-sectional study of adolescents aged 13-19 years was conducted at three secondary schools consisting of 121 females and 97 males. Data on height; weight; and blood pressure was collected from all participants. BMI and BP percentiles were calculated for each participant.

RESULTS

The prevalence of pre-hypertension and hypertension in males was 28.9% and 10.3% compared to 25.6% and 7.4% in females. The prevalence of pre-hypertension and hypertension in adolescents who are overweight/obese was 7.3% and 2.7%. A weak positive association between BMI; systolic blood pressure (SBP) and diastolic blood pressure (DBP) was found (r = 0.254 and 0.216; p-value = 0.001) for the whole population. A significant, moderate correlation was found between BSA on SBP was found (r = 0.407, p-value = 0.001); and a significant, weak correlation between BSA and DBP was found (r = 0.183, p-value = 0.007. In conclusion, the prevalence of pre-hypertension and hypertension was higher in males as compared to females. Results highlight the need for screening for blood pressure and body weight in adolescents; especially in adolescents who were found to have pre-hypertension as they are at high risk of developing hypertension.

Prevalence and determinants of hypertension among students of the University of Kinshasa, Democratic Republic of Congo: a cross-sectional study

BACKGROUND

The 2017 ACC/AHA Guideline categorized blood pressure into 4 levels:normal (SBP<120 and DBP <80mm Hg), elevated (SBP of 120-129 or DBP< 80 mmHg) and stage 1 (SBP of 130-139 or DBP of 80-89 mm Hg) or 2 (SBP≥140 orDBP≥90mmHg). Compared with the JNC7 guideline, the 2017 ACC/AHA guideline recommends using lower SBP and DBP levels to define hypertension.

OBJECTIVE

To determine the prevalence of hypertension as well as associated factors among students of the University of Kinshasa.

METHODS

This was a cross-sectional study conducted at the University of Kinshasa and including 1 281 students aged between 18 and 30. Blood pressure was assessed according to the WHO STEPwise approach, which is a standardized method of data collection, analysis and dissemination for the surveillance of non-communicable diseases in WHO member countries. The Chi-square and Student's t-tests and a multivariate logistic regression analysis have been used to evaluate the results. Statistical analyses were done using IBM SPSS version 21.

RESULTS

The prevalence of hypertension according to the guidelines from the 2017 ACC/AHA and the JNC 7 was 26.4 % (CI 95%; 23.9 - 28.9) and 7.3 % (CI 95%; 5.8 - 8.8), respectively. The results of multivariate logistic regression analysis showed that smoking, alcohol abuse, overweight, male sex, age ≥ 24 years old and low physical activity were associated with hypertension (p < 0.0001).

CONCLUSION

At least one out of four students had hypertension. These data should encourage public health authorities to develop strategies for screening of BP and topromote the adoption of healthy lifestyle in young adults.

Impact of the 2017 American Academy of Pediatrics Guideline on Hypertension Prevalence Compared With the Fourth Report in an International Cohort

In 2017, the American Academy of Pediatrics (AAP) updated the clinical practice guideline for high blood pressure (BP) in the pediatric population. In this study, we compared the difference in prevalence of elevated and hypertensive BP values defined by the 2017 AAP guideline and the 2004 Fourth Report and estimated the cardiovascular risk associated with the reclassification of BP status defined by the AAP guideline. A total of 47 200 children and adolescents aged 6 to 17 years from 6 countries (China, India, Iran, Korea, Poland, and Tunisia) were included in this study. Elevated BP and hypertension were defined according to 2 guidelines. In addition, 1606 children from China, Iran, and Korea who were reclassified upward by the AAP guideline compared with the Fourth Report and for whom laboratory data were available were 1:1 matched with children from the same countries who were normotensive by both guidelines. Compared with the Fourth Report, the prevalence of elevated BP defined by the AAP guideline was lower (14.9% versus 8.6%), whereas the prevalence of stages 1 and 2 hypertension was higher (stage 1, 6.6% versus 14.5%; stage 2, 0.4% versus 1.7%). Additionally, comparison of laboratory data in the case-control study showed that children who were reclassified upward were more likely to have adverse lipid profiles and high fasting blood glucose compared with normotensive children. In conclusion, the prevalence of elevated BP and hypertension varied significantly between both guidelines. Applying the new AAP guideline could identify more children with hypertension who are at increased cardiovascular risk.

Body mass index percentiles and elevated blood pressure among children and adolescents

It is well established that obesity is associated with an increased risk of elevated and high blood pressure (BP) in children and adolescents. However, it is uncertain whether there is an increase in the risk of elevated and high BP associated with an increase of body mass index (BMI) among children and adolescents whose BMI is in the accepted normal range. Data were available for 58 899 children and adolescents aged 6-17 years from seven national cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. The subjects were divided into eight percentile subgroups according to their BMI levels based on the World Health Organization recommendations. Elevated BP and high BP were defined using the 2016 international child BP criteria. Compared with the reference subgroup of the 5th-24th percentiles, the odds ratios (ORs) for high BP were 1.27 (95% confidence interval [CI], 1.14-1.41; P < 0.001) in the 25th-49th percentile subgroup, 1.55 (95% CI, 1.39-1.73; P < 0.001) in the 50th-74th percentile subgroup, and 2.17 (95% CI, 1.92-2.46; P < 0.001) in the 75th-84th percentile subgroup, respectively, after adjustment for sex, age, race/ethnicity, height and country. Additionally, the corresponding ORs for elevated BP were 1.21 (95% CI, 1.10-1.32; P < 0.001), 1.55 (95% CI, 1.42-1.69; P < 0.001), and 1.80 (95% CI, 1.62-2.01; P < 0.001), respectively. In conclusion, a BMI in the 25th-84th percentiles, within the accepted normal weight range, was associated with an increased risk of elevated and high BP among children and adolescents. It is important for children and adolescents to keep a BMI at a low level in order to prevent and control hypertension.

Height-specific blood pressure cutoffs for screening elevated and high blood pressure in children and adolescents: an International Study

Pediatric blood pressure (BP) reference tables are generally based on sex, age, and height and tend to be cumbersome to use in routine clinical practice. In this study, we aimed to develop a new, height-specific simple BP table according to the international child BP reference table based on sex, age and height and to evaluate its performance using international data. We validated the simple table in a derivation cohort that included 58,899 children and adolescents aged 6-17 years from surveys in 7 countries (China, India, Iran, Korea, Poland, Tunisia, and the United States) and in a validation cohort that included 70,072 participants from three other surveys (China, Poland and Seychelles). The BP cutoff values for the simple table were calculated for eight height categories for both the 90th ("elevated BP") and 95th ("high BP") percentiles of BP. The simple table had a high performance to predict high BP compared to the reference table, with high values (boys/girls) of area under the curve (0.94/0.91), sensitivity (88.5%/82.9%), specificity (99.3%/99.7%), positive predictive values (93.9%/97.3%), and negative predictive values (98.5%/97.8%) in the pooled data from 10 studies. The simple table performed similarly well for predicting elevated BP. A simple table based on height only predicts elevated BP and high BP in children and adolescents nearly as well as the international table based on sex, age, and height. This has important implications for simplifying the detection of pediatric high BP in clinical practice.

Body composition and physical activity as mediators in the relationship between socioeconomic status and blood pressure in young South African women: a structural equation model analysis

OBJECTIVES

Varying hypertension prevalence across different socioeconomic strata within a population has been well reported. However, the causal factors and pathways across different settings are less clear, especially in sub-Saharan Africa. Therefore, this study aimed to compare blood pressure (BP) levels and investigate the extent to which socioeconomic status (SES) is associated with BP, in rural and urban South Africa women.

SETTING

Rural and urban South Africa.

DESIGN

Cross-sectional.

PARTICIPANTS

Cross-sectional data on SES, total moderate and vigorous physical activity (MVPA), anthropometric and BP were collected on rural (n=509) and urban (n=510) young black women (18-23 years age). Pregnant and mentally or physically disabled women were excluded from the study.

RESULTS

The prevalence of combined overweight and obesity (46.5% vs 38.8%) and elevated BP (27.0% vs 9.3%) was higher in urban than rural women, respectively. Results from the structural equation modelling showed significant direct positive effects of body mass index (BMI) on systolic BP (SBP) in rural, urban and pooled datasets. Negative direct effects of SES on SBP and positive total effects of SES on SBP were observed in the rural and pooled datasets, respectively. In rural young women, SES had direct positive effects on BMI and was negatively associated with MVPA in urban and pooled analyses. BMI mediated the positive total effects association between SES and SBP in pooled analyses (ß 0.46; 95% CI 0.15 to 0.76).

CONCLUSIONS

Though South Africa is undergoing nutritional and epidemiological transitions, the prevalence of elevated BP still varies between rural and urban young women. The association between SES and SBP varies considerably in economically diverse populations with BMI being the most significant mediator. There is a need to tailor prevention strategies to take into account optimising BMI when designing strategies to reduce future risk of hypertension in young women.

Physical inactivity, gender and culture in Arab countries: a systematic assessment of the literature

Background

Physical inactivity is associated with excess weight and adverse health outcomes. We synthesize the evidence on physical inactivity and its social determinants in Arab countries, with special attention to gender and cultural context.

Methods

We searched MEDLINE, Popline, and SSCI for articles published between 2000 and 2016, assessing the prevalence of physical inactivity and its social determinants. We also included national survey reports on physical activity, and searched for analyses of the social context of physical activity.

Results

We found 172 articles meeting inclusion criteria. Standardized data are available from surveys by the World Health Organization for almost all countries, but journal articles show great variability in definitions, measurements and methodology. Prevalence of inactivity among adults and children/adolescents is high across countries, and is higher among women. Some determinants of physical inactivity in the region (age, gender, low education) are shared with other regions, but specific aspects of the cultural context of the region seem particularly discouraging of physical activity. We draw on social science studies to gain insights into why this is so.

Conclusions

Physical inactivity among Arab adults and children/adolescents is high. Studies using harmonized approaches, rigorous analytic techniques and a deeper examination of context are needed to design appropriate interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5472-z) contains supplementary material, which is available to authorized users.

The effect of obesity and components of metabolic syndrome on leptin levels in Saudi women

BACKGROUND

Leptin levels are reported to be increased with excessive body fat and is a potential determinant of obesity and its complications. Our Objective is to evaluate the relationship between leptin levels and BMI, waist circumference and metabolic syndrome components in normal and obese females classified according to their BMI.

SUBJECTS AND METHODS

A total of 136 female subjects aged between 20 and 60 years were recruited for the current study. Anthropometric measures included body mass index and waist circumference. The blood samples were used for estimation of plasma fasting blood glucose and serum was used for estimation of triglycerides, total cholesterol, low and high density lipoproteins, and total leptin.

RESULTS

Correlation between glucose and lipids profile with waist circumference among the whole study group (obese and non-obese) is reflecting that a strong positive correlation between BMI and blood glucose, serum TGs, cholesterol and LDL, a negative correlation was reported between BMI and serum HDL. Mean of leptin concentrations in two groups were found to be 5.77 ng/ml (±1.00) in non-obese and 28.89 ng/ml (±4.91) in the obese with metabolic syndrome. Leptin had a positive correlations with triglycerides (r = 0.84, p < 0.001), total cholesterol (r = 0.77, p < 0.001), LDL (r = 0.83, p < 0.001), waist circumference (r = 0.86, p < 0.001) and BMI (r = 0.72, p < 0.001) in the test group. a negative correlation was reported between BMI and serum HDL (r = -0.48, p < 0.001).

CONCLUSION

Leptin levels were high in Saudi women with high BMI and waist circumference. There was a significant correlation between leptin levels and Obesity.

Prevalence and complications of obesity and overweight among Algerian adolescents

OBJECTIVE: To determine the prevalence of overweight and obesity in Algerian adolescents and investigate the associated cardiometabolic complications. METHODS: The study was conducted in the city of Constantine (Algeria). The population included 1100 schooled adolescent, aged 12–18 years, randomly selected. All had anthropometric measurements, and 989 had blood tests. The BMI was calculated and the prevalence of overweight and obesity was determined using the International Obesity Task Force reference values. RESULTS: 179 (16.3%) adolescents were overweight including 74 boys (13.8%) and 105 girls (18.6%), 51 (4.6%) adolescents were obese including 25 (4.6%) boys vs 26 (4.6%) girls (p = 0.09). Overweight and obese adolescents had higher systolic blood pressure/diastolic blood pressure (p = 0.001/p < 0.0001) and abnormal blood lipid levels. Furthermore, the HOMA index was higher in overweight and obese adolescents (p < 0.0001). CONCLUSION: These findings show a high prevalence of overweight and obesity in a population of Algerian adolescents leading to significant cardiometabolic abnormalities.

Elevated blood pressure among primary school children in Dar es salaam, Tanzania: prevalence and risk factors

Background

Whilst the burden of non-communicable diseases is increasing in developing countries, little data is available on blood pressure among Tanzanian children. This study aimed at determining the blood pressure profiles and risk factors associated with elevated blood pressure among primary school children in Dar es Salaam, Tanzania.

Methods

We conducted a cross sectional survey among 446 children aged 6–17 years from 9 randomly selected primary schools in Dar es Salaam. We measured blood pressure using a standardized digital blood pressure measuring machine (Omron Digital HEM-907, Tokyo, Japan). We used an average of the three blood pressure readings for analysis. Elevated blood pressure was defined as average systolic or diastolic blood pressure ≥ 90th percentile for age, gender and height.

Results

The proportion of children with elevated blood pressure was 15.2% (pre-hypertension 4.4% and hypertension 10.8%). No significant gender differences were observed in the prevalence of elevated BP. Increasing age and overweight/obese children were significantly associated with elevated BP (p = 0.0029 and p < 0.0001) respectively. Similar associations were observed for age and overweight/obesity with hypertension. (p = 0.0506 and p < 0.0001) respectively. In multivariate analysis, age above 10 years (adjusted RR = 3.63, 95% CI = 1.03–7.82) was significantly and independently associated with elevated BP in this population of school age children.

Conclusions

We observed a higher proportion of elevated BP in this population of school age children. Older age and overweight/obesity were associated with elevated BP. Assessment of BP and BMI should be incorporated in school health program in Tanzania to identify those at risk so that appropriate interventions can be instituted before development of associated complications.

Influence of waist circumference on blood pressure status in non-obese adolescents

Objectives To check whether excess in abdominal adiposity and metabolic factors were associated with blood pressure abnormalities in non-obese adolescents. Methods We randomly selected 1100 adolescent students, aged 12-18 years, from schools and classrooms in the city of Constantine, Algeria. Among them 179 were overweight and 51 were obese (IOTF criteria). Waist circumference (WC) was considered high if >74 cm in boys and 75 cm in girls (mean of WC of all population studied). Hypertension (HBP) and prehypertension (preHBP) were defined by the NHBPEP's 2004 criteria. Results The prevalence of HBP/preHBP were 13.0%/12.4% with no difference between boys and girls. The percentages of HBP/preHBP patients were 15.6%/15.6% in overweight adolescents, 5.9%/31.4% in obese adolescents and 12.9%/10.6% in adolescents with normal body weight (p < 0.0001). In obese adolescents, the prevalence of HBP was higher among boys than girls (36% vs. 27%, p = 0.002). In normal and overweight adolescents, the prevalence of HBP and preHBP was similar in boys and girls (11.9% vs. 11.0% and 14.7% vs. 12.1%); the association of WC (high vs. not high) with HBP was found in boys (16.1% vs. 8.8%, p = 0.009) but not in girls (12.1% vs. 10.2%), and with preHBP in girls (15.5% vs. 8.0%, p = 0.029) but not in boys (16.2% vs. 13.6%). Waist circumference [OR: 1.04 (1.03-1.06); p < 0.0001] and HOMA index [OR: 1.65 (1.13-2.39); p = 0.009] were associated with an increased risk of HBP. Conclusion In non-obese adolescents, a high WC, defined by values over the mean WC observed in our population, is associated with a higher risk of HBP in boys.

Associations of Blood Pressure with the Factors among Adults in Jilin Province: A Cross-Sectional Study Using Quantile Regression Analysis

Hypertension has become a major public health challenge. However, numerous research results reported in the literature focus primarily on risk factors of hypertension, little is known about how the whole continuum of blood pressure (BP) is associated with risk factors of hypertension. This study aims to reveal quantile-specific associations of BP with its risk factors. A cross-sectional survey based on a sample of 23,050 adults aged 18 to 79 years was conducted in Jilin Province in 2012, and some subjects were excluded due to missing values in BP or having BP control according to the purpose of this study. Quantile regression (QR) was employed to investigate the associations between systolic/diastolic blood pressure (SBP/DBP) and the risk factors. The SBP and DBP in males presented statistically higher than females (P < 0.001). High-salt diet for males manifested a slightly increasing positive association with higher SBP only for high quantiles (≥70), but with a higher DBP for middle part of the quantiles (30~75), compared with bland diet. High-salt diet, drinking and high-density lipoprotein cholesterol (HDL-C) were positively associated with BP measures in males. And the coefficient of total cholesterol (TC) in QR increased with BP in females who used to live in town.

Challenges and results of a school-based intervention to manage excess weight among school children in Tunisia 2012-2014

BACKGROUND

Obesity is a serious health issue and predisposes individuals to an increased risk of morbidity and mortality. Its prevalence in children has increased worldwide.

OBJECTIVE

To demonstrate the feasibility and effectiveness of a school-based management program based on healthy lifestyle promotion for obese and overweight adolescents in Sousse, Tunisia.

METHODS

We conducted a quasi-experimental study among overweight and obese school children enrolled in 7th and 8th grades in Sousse, Tunisia with two groups, intervention and control. The 1-year intervention was based on promoting healthy eating and physical activity through a collective intervention for all recruited children and an individual intervention only for obese children who require intensive managing. Data collection was done before, at the end and at a 4-month follow up of the intervention, both in intervention and control groups.

RESULTS

The body mass index Z score decreased significantly from pre-intervention to post-intervention (1.89±0.57 to 1.76±0.63, p<0.001) and from post-intervention to the follow-up (1.76±0.63 to 1.55±0.68, p<0.001) in the intervention group. In the control group, it decreased significantly from pre-intervention to post-intervention but not significantly from post-intervention to follow-up assessment. Calorie intake decreased significantly both in intervention and control groups.

CONCLUSION

This project began with introducing a new culture of health management in schools on one side and with increasing awareness of the importance of obesity prevention and treatment. The support of authorities for this type of action is very important to guarantee its sustainability.

Prevalence of elevated blood pressure in children and adolescents in Africa: a systematic review and meta-analysis

BACKGROUND

Despite substantial attention paid to the threat of elevated blood pressure in children and adolescents in high-income countries and the epidemic of hypertension in African adult populations, data on the burden of elevated blood pressure in African children and adolescents have not yet been synthesised. We did a systematic review and meta-analysis to provide estimates of the prevalence of elevated blood pressure and assess associated factors among children and adolescents in Africa.

METHODS

We searched Embase, PubMed, African Journals Online, and African Index Medicus to identify articles published from Jan 1, 1996, to Feb 2, 2017, and searched the reference list of retrieved articles. Each study was independently reviewed for methodological quality. We used a random-effects model to estimate the prevalence of elevated blood pressure across studies and heterogeneity (I²) was assessed via the χ² test on Cochran's Q statistic. This review is registered with PROSPERO, number CRD42015019029.

FINDINGS

We included 51 studies in qualitative synthesis and 25 in the meta-analysis reporting data of a pooled sample of 54 196 participants aged 2-19 years. Study quality was high with only four medium-quality studies and no low-quality studies. Prevalence of elevated blood pressure varied widely across studies (range 0·2-24·8%). The pooled prevalence of elevated blood pressure (systolic or diastolic blood pressure ≥95th percentile) was 5·5% (95% CI 4·2-6·9), whereas that of slightly elevated blood pressure (systolic or diastolic blood pressure ≥90th percentile and <95th percentile) was 12·7% (2·1-30·4). The prevalence of elevated blood pressure was largely associated with body-mass index (BMI), with a prevalence of elevated blood pressure six times higher in obese (30·8%, 95% CI 20·1-42·6) versus normal-weight children (5·5%, 3·1-8·4; p<0·0001).

INTERPRETATION

This study suggests a high prevalence of elevated blood pressure among children and adolescents in Africa, with overweight and obesity being an important risk factor. Efforts to address this burden of elevated blood pressure in children and adolescents should mainly focus on primary prevention at the community level, by promoting healthy lifestyles and avoiding other cardiovascular risk factors, especially overweight and obesity. This study also stresses the need for more elaborate studies using uniform and reliable diagnostic methods to reliably map the burden of elevated blood pressure in children and adolescents in Africa.

FUNDING

None.

A systematic review of childhood obesity in the Middle East and North Africa (MENA) region: Prevalence and risk factors meta-analysis

Obesity rates are rising globally, but there is evidence that young people in the Middle East and North Africa (MENA) region are at particularly high risk. We systematically searched the literature to map the MENA region for prevalence of childhood overweight and obesity, and examine the underlying risk factors and adverse effects associated with obesity in this region. Inclusion criteria were: English-language, non-basic-science focused articles that used any of the standard obesity definitions and were conducted in the MENA countries within the last five years. We searched PubMed using combinations of key terms ((childhood) OR adolescence) AND obesity) AND (MENA or each country) AND ("last five years" [PDat]). Studies demonstrated an increasing prevalence of obesity among many countries in the MENA region, especially in the Gulf area. Notably, in Kuwait, prevalence rates of overweight and obesity were 25.6% and 34.8% among young males and 20.8% and 20.5% among females. A meta-analysis revealed that physical inactivity, increased screen time, and higher social status were risk factors for childhood obesity. Childhood and adolescent obesity is a major challenge facing countries of the MENA region. Further research is needed to fully investigate the role of nutrition and other specific risk factors and evaluate various interventions to manage this pervasive and growing health problem.

A systematic review of childhood obesity in the Middle East and North Africa (MENA) region: Health impact and management

Childhood obesity has serious consequences both immediately and in adulthood. The rates of obesity in children and adolescents are rising rapidly in the Middle East and North Africa (MENA) region. We systematically searched the literature to explore adverse effects associated with childhood obesity in this region and the management efforts for dealing with it. Inclusion criteria were: English-language, non-basic-science focused articles that used any of the standard obesity definitions and were conducted in the MENA countries within the last five years. We searched PubMed using combinations of key terms ((childhood) OR adolescence) AND obesity) AND (MENA or each country) AND ("last five years" [PDat]). Studies that examined adverse effects of childhood obesity gave fairly consistent results, revealing associations with higher blood pressure, pre-diabetes, metabolic abnormalities, and cardiovascular risk. Little or no overall effect on rates of childhood obesity has yet been demonstrated by interventions used to manage the problem. Obesity has a considerable impact on the health of children and adolescents, and the countries of the MENA region should endorse strategies and programs to prevent and manage this problem in an effective way.

Prevalence and factors associated with hypertension in Burkina Faso: a countrywide cross-sectional study

Background

High blood pressure (HBP) is an increasing public health issue for developing countries. HBP is an important contributing factor to many non-communicable diseases that were until very recently thought to be rare in developing countries. There is not enough evidence on its burden and risk factors in Africa. We report in this study on the prevalence and factors associated with HBP in the adult and active population of Burkina Faso from a nationally representative sample.

Methods

We conducted a secondary analysis of data from the World Health Organization (WHO) Stepwise approach to Surveillance(STEPS) survey on the prevalence of major risk factors for non-communicable diseases in Burkina Faso. This survey was conducted between September 26 and November 18, 2013 and involved a nationally representative sample of 4,800 adults aged 25 to 64 years. The risk factors were identified using a binary logistic regression in STATA Version 13.1 software.

Results

The analysis was conducted on a sample of 4629 participants of whom 72.18% lived in rural areas. The overall prevalence of hypertension in Burkina Faso was 18% (95% CI: 16.19%–19.96%). In urban areas the prevalence was 24.81% (95% CI 20.21%–30.07%) and 15.37% (95% CI 13.67%–17.24%) in rural areas. Increased Body Mass Index (BMI) and older age were consistently associated with higher odds of HBP in both residential areas. In addition, being of male sex, fat intake, family history of HBP and low level of HDL cholesterol were significantly associated with increased odds of HBP in rural residents.

Conclusion

The prevalence of hypertension is high in Burkina Faso with roughly one person in five affected. There is a predominant burden in urban areas with prevalence of ten-point percent higher compared to rural area. Modifiable risk factors should be targeted with appropriate and effective strategies to curb the rising burden of hypertension and its consequences.

Prevalence,awareness and factors associated with hypertension in North West Tanzania

BACKGROUND

Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases.

OBJECTIVE

This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania.

DESIGN

A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants.

RESULTS

Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%.

CONCLUSION

By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension.

Performance of obesity indices for screening elevated blood pressure in pediatric population: Systematic review and meta-analysis

BACKGROUND

Hypertension is closely related with obesity in pediatric population. Obesity indices were used for screening elevated blood pressure (BP) in children and adolescents. The present study was to perform a meta-analysis to assess the performance of obesity indices, body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), for identifying elevated BP in children and adolescents.

METHODS

Data sources were PubMed, EMBASE, Web of Science, Cochrane, and SCOPUS up to May 2016. Studies providing measures of diagnostic performance of obesity indices and using age-, sex-, and height-specific BP 95% as reference standard (the definition of United State Fourth Report) were included. We extracted available data on true-positive, false-positive, true-negative, and false-negative to construct a 2 × 2 contingency table and computed the pooled summary statistics for the sensitivities and specificities to estimate the diagnostic performance.

RESULTS

Nine eligible studies that evaluated 25,424 children and adolescents aged 6 to 18 years were included in the meta-analysis. The pooled sensitivities were 42% (BMI), 42% (WC), and 43% (WHtR). The pooled specificities were 80% (BMI), 75% (WC), and 77% (WHtR). The areas under the curve (AUCs) of obesity indices were 0.7780 (BMI), 0.7181 (WC), and 0.6697 (WHtR), respectively. In this meta-analysis, the BP measurements were based on 3 visits in only 1 study. The prevalence of hypertension may be overestimated in these studies.

CONCLUSIONS

The present meta-analysis showed that the performance of obesity indices for identifying elevated BP was poor. Our findings do not support the performance of WC and WHtR is superior to BMI to help identify children with elevated BP.

Performance of Eleven Simplified Methods for the Identification of Elevated Blood Pressure in Children and Adolescents

The identification of elevated blood pressure (BP) in children and adolescents relies on complex percentile tables. The present study compares the performance of 11 simplified methods for assessing elevated or high BP in children and adolescents using individual-level data from 7 countries. Data on BP were available for a total of 58 899 children and adolescents aged 6 to 17 years from 7 national surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. Performance of the simplified methods for screening elevated or high BP was assessed with receiver operating characteristic curve (area under the curve), sensitivity, specificity, positive predictive value, and negative predictive value. When pooling individual data from the 7 countries, all 11 simplified methods performed well in screening high BP, with high area under the curve values (0.84-0.98), high sensitivity (0.69-1.00), high specificity (0.87-1.00), and high negative predictive values (≥0.98). However, positive predictive value was low for most simplified methods, but reached ≈0.90 for each of the 3 methods, including sex- and age-specific BP references (at the 95th percentile of height), the formula for BP references (at the 95th percentile of height), and the simplified method relying on a child's absolute height. These findings were found independently of sex, age, and geographical location. Similar results were found for simplified methods for screening elevated BP. In conclusion, all 11 simplified methods performed well for identifying high or elevated BP in children and adolescents, but 3 methods performed best and may be most useful for screening purposes.

[Arterial hypertension among adolescents in Rio de Janeiro: prevalence and association with physical activity and obesity]

The scope of this study was to identify the prevalence of systemic arterial hypertension among adolescent students (aged 17-19 years) in the third and final year of high school in state schools in the municipality of Rio de Janeiro, and to investigate associations between systemic arterial hypertension and obesity and physical activity levels. Data on arterial pressure, body mass index and physical activity were gathered. The analysis included 854 individuals. Descriptive statistical analysis was applied to the sample, along with a Poisson regression model to determine the impact of the variables on the prevalence of systemic arterial hypertension. The prevalence of systemic arterial hypertension was 19.4%. Male sex, overweight and obesity presented significant positive associations with systemic arterial hypertension (p < 0.05), while physical activity was not shown to be significantly associated with systemic arterial hypertension (p > 0.05). The nature of these relationships should be interpreted in the light of reflection and not of passive labeling based on hegemonic concepts.

Correlates of Blood Pressure According to Early, On Time, and Late Maturation in Adolescents

The aim of this study was to estimate the prevalence and correlates of blood pressure (BP) according to somatic maturation in Southern Brazilian adolescents. A total of 1321 adolescents participated in the study (732 girls), aged between 10 and 16 years, enrolled in public schools. The assessment of BP was performed using oscillometric equipment. Measurements of body weight, height, waist circumference, and skinfold thickness were performed. Somatic maturation was estimated by the age at peak height velocity. Behavioral and hereditary variables were obtained using a questionnaire. Early-maturing adolescents had the highest prevalence of high BP (28%; 95% confidence interval, 24.6-33.5) compared with other maturational groups (P=.003). In late-maturing adolescents, the variables associated with BP were paternal hypertension (systolic BP: β=4.9; diastolic BP: β=5.3) and early physical activity (systolic BP: β=-4.0; diastolic DBP: β=-3.6). In average-maturing adolescents, waist circumference (systolic BP: β=0.3), body mass index (diastolic BP: β=0.5), and mother's hypertension (diastolic BP: β=1.8) were positively related to BP. In early-maturing adolescents, only waist circumference (systolic BP: β=0.3; diastolic BP: β=0.3) was associated with BP. The authors conclude that the prevalence of high BP is greater in adolescents with early maturity and the outcome appears to be related to biological indicators in this group. On the other hand, in late-maturing adolescents, behavioral and hereditary variables are more related to BP.

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years

BACKGROUND

Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States).

METHODS AND RESULTS

Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar.

CONCLUSIONS

These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

The quality and characteristics of sleep of hypertensive patients

OBJECTIVEAnalyzing the quality of sleep of hypertensive patients registered in the national registration system and monitoring of hypertensive patients.METHODSA cross-sectional study of quantitative and descriptive analyses with 280 hypertensive patients registered in the National Program of Hypertension and Diabetes of the Federal Government in the months from August to October 2011. Questionnaires were used which allowed for tracking sociodemographic data on hypertension and Pittsburgh Sleep Quality Index (PSQI).RESULTSThe prevalence of poor sleep quality among respondents (156 hypertensive patients) and high rates of using medication for sleeping (106 hypertensive patients) was observed. Other relevant data refers to the quality of sleep among hypertensive patients using sleep medication compared to those who do not use it (p≤0.01).CONCLUSIONIndividuals with high blood pressure have a negative association with sleep quality.

Association of obesity with chronic disease and musculoskeletal factors

SummaryIntroduction:overweight and obesity in adolescents are major public health problems with particular interest, because of their potential association with risk factors for development of diseases. The study aimed to determine the prevalence of overweight and obesity in adolescents in southern Portugal and investigate the association with risk factors for development of cardiovascular, respiratory and musculoskeletal diseases.Methods:the sample consisted of 966 adolescents aged 10 to 16 years. The calculation of body mass index (BMI), evaluation of blood glucose, total cholesterol and triglycerides, blood pressure, spirometry and application of low back pain (LBP) questionnaire were performed.Results:178 (18.4%) adolescents were overweight and 52 (5.4%) obese. None of the variables revealed a statistically significant association with overweight and obesity. The presence of high blood pressure was observed in 200 (20.7%) individuals and hypertension in 158 (16.4%) adolescents. Overweight and obese adolescents are 2.3 times more likely to develop signs of pre-hypertension and hypertension. 559 (57.9%) students had restrictive respiratory disorders and 23 (2.4%) had obstructive disorders. Those who were overweight and obese had 0.64 probability of having restrictive respiratory disorders.Conclusion:there was a high prevalence of overweight and obesity in Portuguese adolescents and these showed a statistically significant relationship with the development of pre-hypertension and hypertension, and restrictive respiratory disorders.

Population attributable risk of overweight and obesity for high blood pressure in Chinese children

OBJECTIVE

Little is known about whether eliminating overweight and obesity could effectively reduce the prevalence of high blood pressure (HBP) in Chinese children. This study aimed to estimate the magnitude of contribution of overweight and obesity associated with HBP in Chinese children, and assess the theoretical HBP prevalence if overweight and obesity were eliminated.

METHODS

Data on 197,191 participants aged 7-17 years with complete records from the Chinese National Survey on Students' Constitution and Health conducted in 2010 were included. The population attributable risk of overweight and obesity for HBP was calculated.

RESULTS

The prevalence of HBP was 6.8% and 5.8% for boys and girls, respectively. HBP in about 22.9% (95% CI 21.5, 24.2%) of boys and 14.7% (95% CI 13.5, 15.8%) of girls could be attributable to overweight and obesity. If both overweight and obesity were eliminated, the prevalence of HBP theoretically could be reduced to 5.2% in boys and 5.0% in girls. Similar results were found in different age and urban/rural area groups.

CONCLUSION

Eliminating overweight and obesity could theoretically lead to a moderate reduction in the prevalence of HBP in Chinese children.

Prevalência de hipertensão arterial e seus fatores de risco em adolescentes

Objetivo Avaliar a prevalência de hipertensão arterial e fatores de risco associados entre adolescentes. Métodos Estudo transversal realizado com 211 adolescentes escolares. Foi avaliada a prevalência de hipertensão arterial e verificada a relação desta com o excesso de peso, atividade física e glicemia capilar. Resultados A prevalência de hipertensão arterial foi de 13,7%. Não foram observadas associações da pressão arterial elevada com o excesso de peso e níveis de atividade física. Os adolescentes com glicemia capilar elevada apresentaram maiores chances de desenvolver a hipertensão arterial. Conclusão Os adolescentes apresentaram elevada prevalência de hipertensão arterial. Os casos de hipertensão foram associados apenas com a glicemia capilar elevada.

A frequency questionnaire to estimate free-living physical activity among Tunisian preadolescent and adolescent children

OBJECTIVE

To develop a child- and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa.

DESIGN

A PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days.

SETTING

Two elementary schools and two high schools of the most developed and urbanized area, Greater Tunis.

SUBJECTS

One hundred and forty-two volunteer children and adolescents aged 10-19 years.

RESULTS

The PAFQ strongly was correlated with both HRM (r = 0·70; 95% CI 0·62, 0·76) and 24h-R (r = 0·81; 95% CI 0·77, 0·84). It featured acceptable agreement with both criterion measures, slightly underestimating TEE compared with 24h-R (-2·8%, mean of individual differences -272·7 kJ/d; 95% CI -490·6, -57·4 kJ/d) and moderately overestimating it compared with HRM (+11·3%, mean of individual differences +1106·2 kJ/d; 95% CI 845·8, 1366·6 kJ/d). Reliability ranged from moderate to good (weighted kappa coefficients from 0·47 to 0·78 and intra-class correlation coefficients between 0·79 and 0·86 for energy expenditure by PA categories), indicating strong agreement between the two assessments.

CONCLUSIONS

This PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

Hypertension and associated factors among university students in Gondar, Ethiopia: a cross-sectional study

BACKGROUND

Hypertension causes considerable morbidity and mortality worldwide. However, evidences on the burden of hypertension and associated factors are lacking among college students in resource-poor settings. This study measured the prevalence of hypertension and associated factors among university students in Gondar, Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among randomly selected college students in Gondar, Ethiopia. Trained data collectors administered a pre-tested and structured WHO STEPS questionnaire for data collection. Data were entered using the EPI INFO version 2002 a statistical soft ware. Stata version 11.0 was also employed for descriptive and logistics regression analysis.

RESULTS

A total of 610 college students were screened for hypertension of which 453 (74.4%) were male and 157(25.6%) female with the male to female sex ratio of 2.9:1. The prevalence of hypertension was 7.7%. Higher rates of hypertension were observed among male [AOR: 3.12, 95% CI (1.16- 8.36)], overweight [AOR: 6.92, 95% CI; (2.65-18.07)] and participants who had sleep duration of ≤ 5 hours [AOR: 3.48, 95% CI (1.69-7.15)].

CONCLUSIONS

A high burden of hypertension was observed among college students in Gondar, Ethiopia. Male sex, overweight and sleep duration of ≤ 5 hours were identified as independent risk factors for the disease. Preventive measures, such as increasing awareness and early screening for the disease in young adults warranted.

[Blood pressure and its association with physical activity and obesity in adolescents: a systematic review]

In the light of the importance of the impacts that obesity and physical activity may have on blood pressure (BP) among adolescents, and the suggestion that abnormal pressure levels at young ages are maintained into more mature stages of these individuals' lives, the scope of this study is to conduct a systematic review of the associations between obesity and BP and between physical activity and BP among adolescents. The PubMed database was consulted to search for scientific articles relating to this topic and, after applying the appropriate inclusion and exclusion criteria, 30 articles were selected and analyzed. To assess the quality of articles Strengthening the Reporting of Observational Studies in Epidemiology was applied. The results suggest that despite the existence of hegemonic thinking to guide these relationships, BP and physical activity do not always have negative associations, and BP and obesity do not always have positive associations. The conclusion reached is that this situation illustrates the need for more in-depth reflection on these relationships before pre-established paradigms are passively accepted.

[Prevalence and risk factors of overweight and obesity in a population of school children in urban areas Sfax, Tunisia]

Introduction

L'objectif de ce travail etait d’étudier la prévalence du surpoids et de l'obésité chez un groupe d'enfants d’âge scolaire, habitant la ville de Sfax en Tunisie, et identifier les facteurs favorisant la prise pondérale

Méthodes

Il s'agossait d'une enquête descriptive transversale était réalisée en 2011 sur un échantillon représentatif d’élèves recrutés dans 11 écoles primaires publiques. Des informations concernant les caractéristiques sociodémographiques, les habitudes alimentaires et le comportement sédentaire pour chaque élève ont été précisées au moyen d'un questionnaire

Résultats

Nous avons colligé 1529 élèves, âgés entre 9 et 12 ans et se répartissant en 787 garçons (51,14%) et 747 filles (48,86%). Selon les seuils de référence de l'IOTF, la fréquence de l'obésité était de 2,4% et celle du surpoids était de 6,3%. L'obésité était significativement associée à l'obésité parentale, un niveau socioéconomique élevé, la prise de plus de deux goûters par jour et à l'activité sédentaire.

Conclusion

L'identification des facteurs de risque du surpoids et de l'obésité infantile permettrait de dépister les enfants à risques afin de leur proposer des mesures de prévention adaptées. Ces mesures de prévention devraient inclure non seulement des approches individuelles, mais aussi l'environnement social et physique de l'enfant.

Treatment of obesity-related hypertension in children and adolescents

The obesity epidemic has become a common concern among pediatricians, with an estimated 32 % of US children and adolescents classified as overweight and 18 % as obese. Along with the increase in obesity, a growing body of evidence demonstrates that chronic diseases, such as Type 2 diabetes, primary hypertension, and hyperlipidemia, once thought to be confined solely to adulthood, are commonly seen among the obese in childhood. Following a brief summary of the diagnosis and evaluation of hypertension in obese children and adolescents, this review will highlight recent research on the treatment of obesity-related hypertension. Pharmacologic and non-pharmacologic treatment will be discussed. Additionally, current and emerging therapies for the primary treatment of obesity in children and adolescents, which have been gaining in popularity, will be reviewed.

The effects of an exercise training program on body composition and aerobic capacity parameters in Tunisian obese children

BACKGROUND

The prevalence of children obesity is rising alarmingly in both developed and developing countries. Developing effective exercise programs is a strategy for decreasing this prevalence and limiting obesity-associated long-term comorbidities.

OBJECTIVES

To determine whether a 16-week training program; in addition to the school physical education and without dietary intervention; could have beneficial effects on body composition and aerobic capacity of obese children.

MATERIALS AND METHODS

Twenty-eight obese children (16 boys, 12 girls; aged 12-14 years) were enrolled and were divided into either the exercise group (EG, n = 14) or the control group (CG, n = 14). EG participated in a 16-week aerobic exercises (four 60-min sessions per week at 70-85% of HRmax (maximum heart rate)), in addition to the school physical education. Fat-Free Mass (FFM) and Fat Mass (FM) were assessed with bioelectrical impedance equipment. To assess aerobic capacity, maximal metabolic equivalent of task (METmax) and maximal workload (Wmax) were estimated with an electronically braked cycle ergometer (type Ergoline 500(®)).

RESULTS

At baseline, there were no differences between the two groups. After the training program, only the EG showed significant reduction in BMI (body mass index) and waist circumference compared with the baseline values (P < 0.001). Exercise training significantly decreased FM only in the EG. A significant increase in FFM was seen in both groups; more marked in the EG. There was a significant increase in METmax (P < 0.05) and Wmax (P = 0.02) in the EG, and no significant changes in these parameters were seen in the CG. HRmax significantly decreased only in the EG (P < 0.05).

CONCLUSION

This training program has beneficial effects on body composition and aerobic capacity parameters in obese children. Our intervention has the advantage of providing a sustainable and reproducible school and community approach for the management of children obesity.

Elevated Blood Pressure among Rural South African Children in Thohoyandou, South Africa

BACKGROUND

Whilst there seem to be available data on blood pressure profiles of South African children, especially in urban areas, few data exist on rural children. The aims of this study were to determine the blood pressure profiles of rural South African children residing in Thohoyandou; and to examine the relationship between body mass index and blood pressure among the children.

METHODS

The study involved 296 (134 boys and 135 girls) children aged 7-13 years. Body weight and height were measured using standard procedures. Overweight was defined by body mass index (BMI) for gender and age. Blood pressure was monitored in each child thrice using validated electronic devices (Omron 7051T). Hypertension was determined as the average of three separate blood pressure readings where the systolic or diastolic blood pressure was ≥ 90th percentile for age and sex.

RESULTS

Overweight among the girls (4.7%) was higher compared with the boys (3.9%). Both systolic and diastolic pressures (SBP and DBP) increase with age in both sexes. The proportion of children with > 90th percentile occur at only ages 12 and 13 years. The incidence of hypertension (SBP > 90th percentile) was 0.4% and 0.2% in boys and girls, respectively. The SBP and DBP pressures significantly (P<0.05) correlate with age; body mass, height and BMI.

CONCLUSION

Elevated blood pressure is prevalent among rural South African children residing in this region. Also, blood pressure increased with age in both boys and girls, and this positively correlated with age, body weight, height and BMI.