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Nsanya MK, Abramson R, Kisigo GA, Hickner A, Nyanza EC, Peck RN, Kapiga SH. Hypertension among adolescents in sub-Saharan Africa: a systematic review. Front Cardiovasc Med 2023; 10:1251817. [PMID: 38155990 PMCID: PMC10754047 DOI: 10.3389/fcvm.2023.1251817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction Hypertension (HTN) among adolescents is common in high-income countries, and leads to increased premature cardiovascular diseases (CVD). In sub-Saharan Africa (SSA), the prevalence of HTN among adolescents, associated risk factors and CVD complications are not well-described. Such data is needed for planning public health programs to prevent premature CVD in SSA. Methods We systematically searched 5 databases (MEDLINE, Embase, Google Scholar, Web of Science, and African Index Medicus) from their establishment to December 2021. Key search terms were: adolescent, arterial hypertension, and names of the 48 countries in SSA. We used Covidence® to manage the search results. The review was registered in the Open Science Framework (OSF) https://osf.io/p5sbt/. Results We identified 4,008 articles out of which we screened 3,088 abstracts, and reviewed 583 full-text articles. We finally included 92 articles that were published between 1968 to December 2021. The majority were cross-sectional studies (80%) and conducted in school settings (78%). The risk of bias was low for 59 studies (64.1%), moderate for 29 studies (31.5%), and high for 4 studies (4.3%). Overall, the prevalence of HTN varied widely from 0.18% to 34.0% with a median (IQR) of 5.5% (3.1%, 11.1%). It was relatively higher in studies using automated blood pressure (BP) devices, and in studies defining HTN using thresholds based on percentile BP distribution for one's height, age, and sex. In addition, the prevalence of HTN was significantly higher in studies from Southern Africa region of SSA and positively correlated with the year of publication. Across studies, traditional risk factors such as age, sex, body mass index, and physical inactivity, were commonly found to be associated with HTN. In contrast, non-traditional risk factors related to poverty and tropical diseases were rarely assessed. Only three studies investigated the CVD complications related to HTN in the study population. Conclusion The prevalence of HTN among adolescents in SSA is high indicating that this is a major health problem. Data on non-traditional risk factors and complications are scarce. Longitudinal studies are needed to clearly define the rates, causes, and complications of HTN. Systematic Review Registration https://osf.io/p5sbt/, identifier (10.17605/OSF.IO/P5SBT).
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Affiliation(s)
- Mussa K Nsanya
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
| | - Rachel Abramson
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Godfrey A Kisigo
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andy Hickner
- Weill Cornell Medicine - Cornell University, New York, NY, United States
| | - Elias C Nyanza
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Robert N Peck
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Weill Cornell Medicine - Cornell University, New York, NY, United States
- Catholic University of Health and Allied Sciences, School of Public Health, Mwanza, Tanzania
| | - Saidi H Kapiga
- Mwanza Intervention Trials Unit/National Institute for Medical Research, Mwanza, Tanzania
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Katanic B, Bjelica D, Stankovic M, Milosevic Z, Vukovic J, Mekic A. Anthropometric Characteristics and Weight Status of Early Adolescents (Aged 12-14) in Montenegro; Urban-Rural and Regional Differences. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1664. [PMID: 37892327 PMCID: PMC10605907 DOI: 10.3390/children10101664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
The aim of this study was to determine urban-rural and regional differences in anthropometric characteristics among adolescents aged 12-14, as well as to present the prevalence of weight status. A total of 534 adolescents aged 12-14 from primary schools across Montenegro participated in this cross-sectional study (283 boys, aged 13.52 ± 0.42, body height 169.43 ± 8.89, body weight 60.54 ± 13.47; 251 girls, aged 13.51 ± 0.40, body height 165.54 ± 6.67, body weight 55.28 ± 9.27). The sample was divided by geographic region in Montenegro into northern, central, and coastal regions, and according to settlement type into urban and rural inhabitants. Anthropometric characteristics were assessed using a battery of seven variables: arm span (AS); body height (BH); body weight (BW); waist circumference (WC); hip circumference (HC); body mass index (BMI); and waist-to-hip ratio (WHR). BMI was categorized based on the World Health Organization's (WHO) cut-offs. The results indicate that girls from urban areas exhibited significantly greater body height and lower BMI values compared to their rural counterparts. Similarly, boys from urban areas also demonstrated lower BMI values compared to their rural peers. However, no statistically significant differences were observed in other anthropometric characteristics between these two groups of adolescents. Based on analysis of variance (ANOVA) and post-hoc analysis, it was found that girls from central areas had significantly greater body height compared to those from northern and coastal areas. Likewise, boys from northern areas showed higher body mass and BMI values compared to those from central areas. Additionally, both boys and girls from central areas had higher values compared to those from coastal areas. Nevertheless, no significant differences were detected in other anthropometric characteristics among adolescents from these regions. This study identified significant differences in anthropometric parameters among participants based on urban-rural status and within regional divisions. However, further research encompassing a larger sub-sample and a broader array of anthropometric variables is needed to draw a more comprehensive conclusion.
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Affiliation(s)
- Borko Katanic
- Faculty of Sport and Physical Education, University of Nis, 18000 Nis, Serbia;
| | - Dusko Bjelica
- Faculty for Sports and Physical Education, University of Montenegro, 81400 Niksic, Montenegro;
| | - Mima Stankovic
- Faculty of Sport and Physical Education, University of Nis, 18000 Nis, Serbia;
| | - Zoran Milosevic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.M.); (J.V.)
| | - Jovan Vukovic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (Z.M.); (J.V.)
| | - Amel Mekic
- Faculty of Sports and Physical Education, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
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Craig A, Breet Y, Gafane-Matemane LF, Norris SA, Kruger R. Detecting and Managing Childhood Onset Hypertension in Africa: A Call to Action. Curr Hypertens Rep 2023; 25:211-230. [PMID: 37318686 PMCID: PMC10491553 DOI: 10.1007/s11906-023-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE OF REVIEW To review recent evidence on childhood hypertension across Africa, identifying knowledge gaps, challenges and priorities, and highlight clinical perspectives in managing primary hypertension. RECENT FINDINGS Only 15 of the 54 African countries reported on absolute blood pressure (BP) measures, elevated BP, pre- and/or hypertension. The reported hypertension prevalence ranged between 0.0 and 38.9%, while elevated BP and/or pre-hypertnesion ranged from 2.7 to 50.5%. Childhood BP nomograms are lacking across Africa and the rates of hypertension were based on guidelines developed in countries with the lowest to no number of children from African ancestry. The recent studies across Africa also showed little to no detail when reporting BP specific methodology. No recent data informing the use or effectiveness of antihypertensive agents in children and adolesents are available. Childhood hypertension is on the rise, while data from Africa remains vastly under-represented. Collaborative research, resources, and policies need to be strengthened in addressing the growing public health concern of childhood onset hypertension on this continent.
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Affiliation(s)
- A Craig
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Y Breet
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - L F Gafane-Matemane
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - S A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - R Kruger
- Hypertension in Africa Research Team (HART), North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
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Chen A, Waite L, Mocumbi AO, Chan YK, Beilby J, Ojji DB, Stewart S. Elevated blood pressure among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health 2023; 11:e1238-e1248. [PMID: 37474231 DOI: 10.1016/s2214-109x(23)00218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND More people from sub-Saharan Africa aged between 20 years and 60 years are affected by end-organ damage due to underlying hypertension than people in high-income countries. However, there is a paucity of data on the pattern of elevated blood pressure among adolescents aged 10-19 years in sub-Saharan Africa. We aimed to provide pooled estimates of high blood pressure prevalence and mean levels in adolescents aged 10-19 years across sub-Saharan Africa. METHODS In this systematic review and meta-analysis, we searched PubMed, Google Scholar, African Index Medicus, and Embase to identify studies published from Jan 1, 2010, to Dec 31, 2021. To be included, primary studies had to be observational studies of adolescents aged 10-19 years residing in sub-Saharan African countries reporting the pooled prevalence of elevated blood pressure or with enough data to compute these estimates. We excluded studies on non-systemic hypertension, in African people not living in sub-Saharan Africa, with participant selection based on the presence of hypertension, and with adult cohorts in which we could not disaggregate data for adolescents. We independently extracted relevant data from individual studies using a standard data extraction form. We used a random-effects model to estimate the pooled prevalence of elevated blood pressure and mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels overall and on a sex-specific basis. This study is registered with PROSPERO (CRD42022297948). FINDINGS We identified 2559 studies, and assessed 81 full-text studies for eligibility, of which 36 studies comprising 37 926 participants aged 10-19 years from ten (20%) of 49 sub-Saharan African countries were eligible. A pooled sample of 29 696 adolescents informed meta-analyses of elevated blood pressure and 27 155 adolescents informed meta-analyses of mean blood pressure. Sex data were available from 26 818 adolescents (14 369 [53·6%] were female and 12 449 [46·4%] were male) for the prevalence of elevated blood pressure and 23 777 adolescents (12 864 [54·1%] were female and 10 913 [45·9%] were male) for mean blood pressure. Study quality was high, with no low-quality studies. The reported prevalence of elevated blood pressure ranged from 4 (0·2%) of 1727 to 1755 (25·1%) of 6980 (pooled prevalence 9·9%, 95% CI 7·3-12·5; I?=99·2%, pheterogeneity<0·0001). Mean SBP was 111 mm Hg (95% CI 108-114) and mean DBP was 68 mm Hg (66-70). 13·4% (95% CI 12·9-13·9; pheterogeneity<0·0001) of male participants had elevated blood pressure compared with 11·9% (11·3-12·4; pheterogeneity<0·0001) of female participants (odds ratio 1·04, 95% CI 0·81-1·34; pheterogeneity<0·0001). INTERPRETATION To our knowledge, this systematic review and meta-analysis is the first systematic synthesis of blood pressure data specifically derived from adolescents in sub-Saharan Africa. Although many low-income countries were not represented in our study, our findings suggest that approximately one in ten adolescents have elevated blood pressure across sub-Saharan Africa. Accordingly, there is an urgent need to improve preventive heart-health programmes in the region. FUNDING None.
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Affiliation(s)
| | - Laura Waite
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Ana O Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Justin Beilby
- Torrens University Australia, Adelaide, SA, Australia
| | - Dike B Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique; Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa; Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Yuan M, Li Q, Yang C, Zhi L, Zhuang W, Xu XS, Tao F. Waist-to-Height Ratio Is a Stronger Mediator in the Association between DASH Diet and Hypertension: Potential Micro/Macro Nutrients Intake Pathways. Nutrients 2023; 15:2189. [PMID: 37432361 DOI: 10.3390/nu15092189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 07/12/2023] Open
Abstract
Several studies have demonstrated that adhering to the Dietary Approaches to Stop Hypertension (DASH) diet may result in decreased blood pressure levels and hypertension risk. This may be an effect of a reduction in central obesity. In the current study, we explored the mediation role of multiple anthropometric measurements in association with DASH score and hypertension risk, and we investigated potential common micro/macro nutrients that react with the obesity-reduction mechanism. Our study used data from the National Health and Nutrition Examination Survey (NHANES). Important demographic variables, such as gender, race, age, marital status, education attainment, poverty income ratio, and lifestyle habits such as smoking, alcohol drinking, and physical activity were collected. Various anthropometric measurements, including weight, waist circumference, body mass index (BMI), and waist-to-height ratio (WHtR) were also obtained from the official website. The nutrient intake of 8224 adults was quantified through a combination of interviews and laboratory tests. We conducted stepwise regression to filter the most important anthropometric measurements and performed a multiple mediation analysis to test whether the selected anthropometric measurements had mediation effects on the total effect of the DASH diet on hypertension. Random forest models were conducted to identify nutrient subsets associated with the DASH score and anthropometric measurements. Finally, associations between common nutrients and DASH score, anthropometric measurements, and risk of hypertension were respectively evaluated by a logistic regression model adjusting for possible confounders. Our study revealed that BMI and WHtR acted as full mediators between DASH score and high blood pressure levels. Together, they accounted for more than 45% of the variation in hypertension. Interestingly, WHtR was found to be the strongest mediator, explaining approximate 80% of the mediating effect. Furthermore, we identified a group of three commonly consumed nutrients (sodium, potassium, and octadecatrienoic acid) that had opposing effects on DASH score and anthropometric measurements. These nutrients were also found to be associated with hypertension in the same way as BMI and WHtR in univariate regression models. The most important among these nutrients was sodium, which was negatively correlated with the DASH score (β = -0.53, 95% CI = -0.56~-0.50, p < 0.001) and had a positive association with BMI (β = 0.04, 95% CI = 0.01~0.07, p = 0.02), WHtR (β = 0.06, 95% CI = 0.03~0.09, p < 0.001), and hypertension (OR = 1.09, 95% CI = 1.01~1.19, p = 0.037). Our investigation revealed that the WHtR exerts a greater mediating effect than BMI on the correlation between the DASH diet and hypertension. Notably, we identified a plausible nutrient intake pathway involving sodium, potassium, and octadecatrienoic acid. Our findings suggested that lifestyle modifications that emphasize the reduction of central obesity and the attainment of a well-balanced micro/macro nutrient profile, such as the DASH diet, could potentially be efficacious in managing hypertension.
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Affiliation(s)
- Min Yuan
- School of Public Health Administration, Anhui Medical University, Hefei 230032, China
| | - Qi Li
- School of Public Health Administration, Anhui Medical University, Hefei 230032, China
| | - Can Yang
- School of Public Health Administration, Anhui Medical University, Hefei 230032, China
| | - Liping Zhi
- School of Public Health Administration, Anhui Medical University, Hefei 230032, China
| | - Weiwei Zhuang
- School of Management, University of Science and Technology of China, Hefei 230026, China
| | - Xu Steven Xu
- Clinical Pharmacology and Quantitative Science, Genmab Inc., Princeton, NJ 08536, USA
| | - Fangbiao Tao
- School of Public Health, Anhui Medical University, Hefei 230032, China
- MOE Key Laboratory of Population Health across Life Cycle, Hefei 230032, China
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Adeomi AA, Fatusi A, Klipstein-Grobusch K. 'Children eat all things here': a qualitative study of mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in two Nigerian states. BMJ Open 2022; 12:e059020. [PMID: 35387832 PMCID: PMC8987745 DOI: 10.1136/bmjopen-2021-059020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The perception of mothers about causes of underweight and overweight among children or adolescents and associated cultural beliefs may influence nutritional status. However, data from qualitative studies on this subject and regarding age 6-19 are scarce in Nigeria. OBJECTIVE This study aimed to explore mothers' perceptions and cultural beliefs about underweight and overweight children and adolescents in selected communities in a northern and a southern Nigerian state. DESIGN This was a qualitative study using focus group discussions (FGD). Eight FGD sessions were held. The interviews were transcribed verbatim, and the transcripts were coded and analysed using NVivo V.11, and direct quotations representing the themes generated from the perspectives were cited as appropriate. SETTING The study was carried out in eight randomly selected rural and urban communities in Gombe and Osun states of Nigeria. PARTICIPANTS Seventy-six mothers of children and adolescents aged 6-19 years. RESULTS The mothers identified concepts, causes and community experience of underweight and overweight children and adolescents, however, some gaps and misconceptions were observed. These included perspectives that suggest a limited understanding of the concepts of mild and moderate malnutrition and stunting and citing of 'witches and wizards' as causes of malnutrition. The mothers observed that being underweight was more prevalent in rural communities of Osun and Gombe states, while overweight was more prevalent in urban communities in Osun state. The majority of the women reported no known food taboo or restrictions, and no cultural beliefs relating to the nutrition of children and adolescents. CONCLUSION Gaps and misconceptions exist in the perceptions of mothers on underweight and overweight children and adolescents. Food taboos, food restrictions and other cultural beliefs were not reported by majority of the mothers. Educational programmes for mothers on child/adolescent nutrition should target identified gaps and misconceptions.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Community Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
| | - Adesegun Fatusi
- Community Health, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Community Medicine, University of Medical Sciences, New York, Ondo, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
- Division of Epidemiology & Biostatistics, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
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Adeomi AA, Fatusi A, Klipstein-Grobusch K. Individual and contextual factors associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states: a multi-level analysis. Public Health Nutr 2022; 25:1-13. [PMID: 35067272 PMCID: PMC9991795 DOI: 10.1017/s1368980022000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/22/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to identify individual and contextual factors that are associated with under- and over-nutrition among school-aged children and adolescents in two Nigerian states. DESIGN Community-based cross-sectional study. SETTING The study was carried out in rural and urban communities of Osun and Gombe States in Nigeria. PARTICIPANTS A total of 1200 school-aged children and adolescents. RESULTS Multi-level analysis showed that the full models accounted for about 82 % and 39 % of the odds of thinness or overweight/obese across the communities, respectively. Household size (adjusted OR (aOR) 1·10; P = 0·001; 95 % CI (1·04, 1·16)) increased the odds, while the upper wealth index (aOR 0·43; P = 0·016; 95 % CI (0·22, 0·86)) decreased the odds of thinness. Age (aOR 0·86; P < 0·001; 95 % CI (1·26, 8·70)), exclusive breastfeeding (aOR 0·46; P = 0·010; 95 % CI (0·25, 0·83)), physical activity (aOR 0·55; P = 0·001; 95 % CI (0·39, 0·78)) and the upper wealth index (aOR 0·47; P = 0·018; 95 % CI (0·25, 0·88)) were inversely related with overweight/obesity, while residing in Osun State (aOR 3·32; P = 0·015; 95 % CI (1·26, 1·70)), female gender (aOR 1·73; P = 0·015; 95 % CI (1·11, 2·69)) and screen time > 2 h/d (aOR 2·33; P = 0·005; 95 % CI (1·29, 4·19)) were positively associated with overweight/obesity. CONCLUSIONS The study shows that selected community and individual-level factors are strongly associated with thinness and overweight/obesity among school-aged children and adolescents.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adesegun Fatusi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
- Centre for Adolescent Health and Development, School of Public Health, University of Medical Sciences, Ondo, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
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Crouch SH, Soepnel LM, Kolkenbeck-Ruh A, Maposa I, Naidoo S, Davies J, Norris SA, Ware LJ. Paediatric Hypertension in Africa: A Systematic Review and Meta-Analysis. EClinicalMedicine 2022; 43:101229. [PMID: 34917909 PMCID: PMC8665406 DOI: 10.1016/j.eclinm.2021.101229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The burden of cardiovascular disease (CVD) and hypertension is rapidly increasing in low- and middle-income countries. This is evident not only in adults, but also in children. Recent estimates of prevalence in children are lacking, particularly in Africa. As such, we conducted a systematic review and meta-analysis to provide updated estimates of paediatric hypertension in Africa. METHODS We searched PubMed and EBSCO to identify articles published from January 2017 to November 2020. Studies were assessed for quality. We combined results for meta-analyses using a random effects model (Freeman-Tukey arcsine transformation). Heterogeneity was quantified using the I2 statistic. FINDINGS In the narrative synthesis of 53 studies, publication bias was low for 28, moderate for 24, and high for one study. Hypertension prevalence ranged substantially (0·2%-38·9%). Meta-analysis included 41 studies resulting in data on 52918 participants aged 3 to 19 years from ten countries. The pooled prevalence for hypertension (systolic/diastolic BP≥95th percentile) was 7·45% (95%CI 5·30-9·92, I2=98.96%), elevated blood pressure (BP, systolic/diastolic BP≥90th percentile and <95th percentile) 11·38% (95%CI 7·94-15·33, I2=98.97%) and combined hypertension/elevated BP 21·74% (95%CI 15·5-28·69, I2=99.48%). Participants categorized as overweight/with obesity had a higher prevalence of hypertension (18·5% [95%CI 10·2-28·5]) than those categorized as underweight/normal (1·0% [95%CI 0·1-2·6], 4·8% [95%CI 2·9-7·1], p<0·001). There were significant differences in hypertension prevalence when comparing BP measurement methods and classification guidelines. INTERPRETATION Compared to a previous systematic review conducted in 2017, this study suggests a continued increase in prevalence of paediatric hypertension in Africa, and highlights the potential role of increasing overweight/obesity. FUNDING This research was funded in part by the Wellcome Trust [Grant number:214082/Z/18/Z]. LJW and SAN are supported by the DSI-NRF Centre of Human Development at the University of the Witwatersrand.
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Affiliation(s)
- Simone H. Crouch
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M. Soepnel
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Correspondence and reprint to: Dr. Larske M. Soepnel. Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Huispost nr. STR 6.131 P.O. Box 85500 3508 GA, Utrecht, The Netherlands
| | - Andrea Kolkenbeck-Ruh
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa School of Public Health
| | - Sanushka Naidoo
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Justine Davies
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Human Development, University of Southampton, Southampton, United Kingdom
| | - Lisa J. Ware
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
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Adeomi A, Fatusi A, Klipstein-Grobusch K. Double burden of malnutrition among school-aged children and adolescents: evidence from a community-based cross-sectional survey in two Nigerian States. AAS Open Res 2021; 4:38. [PMID: 34805744 PMCID: PMC8546731 DOI: 10.12688/aasopenres.13257.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Double burden of malnutrition (DBM) is the co-existence of overweight/obesity and undernutrition. Rising prevalence rates of childhood overweight/obesity in Nigeria have been reported, whilst undernutrition continues to be prevalent. This study aimed to estimate the prevalence and distribution of underweight, stunting, thinness, overweight/obesity, and DBM among school-aged children and adolescents in two Nigerian States. Methods: This was a community-based cross-sectional study carried out in Osun and Gombe States. A total of 1,200 children aged 6 - 19 years were recruited using multi-stage sampling technique. Weight, height and data on demographic, socio-economic, household/family characteristics of the children were collected using structured interviewer administered questionnaires. Nutritional status was calculated using the WHO 2007 reference values using BMI-for-age (thinness, overweight/obesity), height-for-age (stunting) and weight-for-age (underweight). DBM was described at the population and individual levels. Results: The mean age of the respondents was 11.6 ± 3.8 years. The overall prevalence rate of stunting was 34.9%, underweight was 13.5%, thinness was 10.3% and overweight/obese was 11.4% and 4.0% had individual level DBM, which typifies the DBM at individual and population levels. These rates differed significantly across demographic, socio-economic and household/family characteristics (p < 0.05). Gombe State, which is in the Northern part of Nigeria, had significantly higher burden of stunted, underweight and thin children than Osun State, while Osun State, in the Southern part of Nigeria, had a significantly higher burden of overweight/obesity. Conclusions: The study found evidence of DBM both at population and individual levels. The overall prevalence rates of stunting, underweight, thinness and overweight/obesity in this study were high, and they differed significantly across the demographic, socio-economic and household/family characteristics. There is the need for government and all other stakeholders to design nutritional educational programmes that will target both under- and over-nutrition among older children in the different contexts.
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Affiliation(s)
- Adeleye Adeomi
- Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, 220, Nigeria.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adesegun Fatusi
- Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, 220, Nigeria.,School of Public Health, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Kerstin Klipstein-Grobusch
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Babadi ME, Mansouri A, Nouri F, Mohammadifard N, Gharipour M, Jozan M, Rabiei K, Azarm T, Khosravi A. Morning Exercise at School and Sedentary Activities are Important Determinants for Hypertension in Adolescents. Int J Prev Med 2021; 12:131. [PMID: 34912507 PMCID: PMC8631126 DOI: 10.4103/ijpvm.ijpvm_41_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 01/03/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study was performed to determine the association of Pre-hypertension/hypertension (pre-HTN/HTN) with leisure-time activities and morning exercise at school in a sample of Iranian adolescents. METHODS This secondary study has done using data of 1992 adolescents participated in of Isfahan Healthy Heart Program. The outcome variable was having/not having pre-hypertension/hypertension (pre-HTN/HTN). The students with Blood pressure (BP) between 90th to 95th percentiles were considered as positive pre-HTN and students with BP >95th percentile were considered as positive HTN. Students with pre-HTN or HTN were considered as positive pre-HTN/HTN. The asked leisure-time activities were categorized in three group including first (ping-pong, basketball, and volleyball), second (football, walking, and bicycling) and sedentary activities (watching TV, studying, and computer gaming), using factor analysis. RESULTS The prevalence of pre-HTN and HTN was 16.1% and 6.7%, respectively. Based on multiple logistic regression pre-HTN/HTN was associated just with sedentary activities and morning exercise at school. Odds Ratio (95% confidence interval) for sedentary activities and morning exercise at school was 1.51 (1.13-2.01) and 0.63 (0.44-0.89), respectively. CONCLUSION We observed adolescents who engaged in morning exercise at school had lower prevalence of HTN while those who spent more times on sedentary activities were in higher risk for HTN. We suggest to permanent holding of morning exercise and educational programs on healthy lifestyle skills for adolescents by schools.
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Affiliation(s)
- Maryam Eghbali Babadi
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Mansouri
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Nouri
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Gharipour
- Department of Metabolic Syndrome, Isfahan Cardiovascular Research Center, Isfahan University of Medicine Sciences, Isfahan, Iran
| | - Mahnaz Jozan
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katayoun Rabiei
- Department of Metabolic Syndrome, Isfahan Cardiovascular Research Center, Isfahan University of Medicine Sciences, Isfahan, Iran
| | - Taleb Azarm
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Interventional Cardiology Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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AKINDELE AKINWUMIOYEWOLE, ADEBAYO AYODEJIMATTHEW. Social connectedness and health risk behaviours among in-school adolescents in urban and rural areas of Oyo State, Nigeria. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E689-E703. [PMID: 34909497 PMCID: PMC8639121 DOI: 10.15167/2421-4248/jpmh2021.62.3.2107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/03/2021] [Indexed: 06/14/2023]
Abstract
Adolescents are considered vulnerable due to their ability to venture into Health Risk Behaviours (HRBs) that may have a long-term detrimental effect on their total wellbeing. The major focus of previous adolescents' studies in Nigeria has been on parent-adolescent communication and the relationship it has with their academic performance and sexual behaviour; none has explored the association of social connectedness and HRBs among in-school adolescents. Thus, the aim of this study is to assess and compare social connectedness and HRBs among in-school adolescents in urban and rural areas of Oyo State. A school-based comparative cross-sectional design was employed wherein 2071 in-school adolescents were selected via a multistage cluster sampling in Ibarapa Central and Ibadan North Local Government Areas (LGAs) of Oyo State. The independent variables were socio-demographic characteristics, family characteristics and social connectedness while the dependent variable was HRBs. The data was analysed using descriptive statistics, chi square, t-test, ANOVA and logistic regression with level of statistical significance set at 5%. Overall, slightly over one-half of the respondents (51.9%) were from the urban LGA and 54.2% were females. The mean age of respondents was 13.7 ± 2.1 years and 46.7% were early adolescents aged 10-13 years. The prevalence of HRBs among in-school adolescents was high (91.8%) and the mean score of social connectedness among in-school adolescents was high, with a slightly higher mean in rural area (131.71 ± 16.43) compared to (131.04 ± 14.47) in urban area. However, this was not statistically significant (p = 0.322). The mean scores of the domains of religious connectedness (p = 0.176), school connectedness (p < 0.001), peer connectedness (p < 0.001) and social-media connectedness (p = 0.003) were higher in the rural areas. However, the mean score of family connectedness among respondents was higher in the urban area (p < 0.001). The odds of having engaged in HRBs were significantly 1.57 times more likely among respondents who were males than those who were females {AOR = 1.57, 95% CI: 1.12-2.19}. The odds of having engaged in HRBs was significantly 1.44 times more likely among respondents who live in an urban area than among those who live in a rural area {AOR = 1.44, 95% CI: 1.03-2.01}. For a unit increase in the total score of social-media connectedness of the students, the odds of having engaged in HRBs was reduced by 0.95 {AOR = 0.95, 95% CI: 0.92-0.99}. There were significantly lower mean scores for social connectedness among respondents who had engaged in HRBs compared to their counterpart who had not engaged in HRBs. Therefore, various efforts targeted at improving social connectedness with its domains could be recommended to prevent in-school adolescents from engaging in HRBs.
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Affiliation(s)
| | - AYODEJI MATTHEW ADEBAYO
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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12
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Chmiel Z, Żal M, Więch P, Bazaliński D, Sałacińska I, Bartusik-Aebisher D, Binkowska-Bury M. Hypertension and selected indicators of health assessment in a population of 19-year-old men subject to military qualifications. Medicine (Baltimore) 2020; 99:e20398. [PMID: 32481430 DOI: 10.1097/md.0000000000020398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Assessment the prevalence of hypertension and its relation to selected indicators of health status and performance, including classification of BMI, obesity classifications, and body structure in a large test group of 19-year-old men.The study was observational-retrospective, and included a group of 17,282 men, aged 19, from the Małopolska region. All subjects met the qualifications for compulsory military service in 2017. We analyzed selected data obtained from the records of the Ministry of National Defense-spiral-ZINT. Data collection and analysis were carried out from April 1, 2018 to August 31, 2018.Hypertension was found at 0.6%, weak body structure at 0.8% and obesityco-existing with cardiorespiratory insufficiency has been reported 2.6% of respondents and it was more frequent in the recruiters from HT II than I. The underweight concerned almost 7%, and the overweight and obesity of 1/4 of conscripts. The vast majority of people with hypertension were characterized by excessive body weight (74.8%), mainly overweight.Hypertension was seen in a negligible percentage of males studied and was significantly associated with an increase in BMI, particularly with regards to being overweight.
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Affiliation(s)
- Zdzisława Chmiel
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Marcin Żal
- Head of the Provincial Military Staff in Krakow, Rydla 19, 30-901 Krakow
| | - Paweł Więch
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dariusz Bazaliński
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Izabela Sałacińska
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
| | - Dorota Bartusik-Aebisher
- Institute of Medical Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow, Poland
| | - Monika Binkowska-Bury
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr.W. Kopisto 2 a, 35 - 310 Rzeszow
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Adeomi AA, Adelusi IO, Adedeji PO, Awofeso AE, Oroleye OO, Gbadegesin DL. Nutritional status and Cardiometabolic health among adolescents; findings from southwestern Nigeria. BMC Nutr 2019; 5:45. [PMID: 32153958 PMCID: PMC7050742 DOI: 10.1186/s40795-019-0308-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity has been associated with an increased risk for cardio-metabolic diseases. The prevalence of obesity among adolescents is increasing worldwide, including Nigeria, but only little data exist on the relationship of nutritional status with cardio-metabolic health among adolescents in Nigeria. This study therefore investigated the relationship of nutrition status, raised blood pressure, glucose intolerance and risk for metabolic diseases among adolescents in southwestern Nigeria. METHODS This was a cross-sectional study conducted among 313 in-school adolescents in Ile-Ife, southwestern Nigeria. The respondents were selected using multi-stage sampling technique, and data were collected using pre-tested structured questionnaires. Anthropometric, blood pressure and random blood glucose measurements were done using standard protocols. Nutritional assessment was done using the World Health Organization (WHO) 2007 reference. Pre-hypertension and hypertension were measured using percentiles for gender, age and height. Analysis was done using IBM SPSS and the level of significance was set at p ≤ 0.05. RESULTS The mean age of the respondents was 14.4 ± 2.0 years. The prevalence of overweight and obesity was 10.2%, and it was significantly higher among females (12.5%) than males (7.0%). The prevalence of systolic and diastolic pre-hypertension was 10.9 and 11.5% respectively, while the prevalence for systolic and diastolic hypertension were 14.4 and 8.6% respectively. Using WHtR to assess cardio-metabolic risk, 7.3% of the respondents were at risk. There were statistically significant relationships between BMI, WHtR and blood pressure levels (< 0.05). CONCLUSIONS The prevalence of overweight/obesity among the adolescents was relatively high, and this was significantly associated with elevated blood pressure and increased risk for cardio-metabolic diseases. There is need for more interest and intervention by stakeholders into the cardio-metabolic health of adolescents in Nigeria.
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Affiliation(s)
- Adeleye Abiodun Adeomi
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
| | - Iyanuoluwa Odunayo Adelusi
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
| | - Praise Oluwatooni Adedeji
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
| | - Adedoyin Esther Awofeso
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
| | - Olajumoke Omotoyosi Oroleye
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
| | - Doyinfunmi Lydia Gbadegesin
- Community Health Department, Obafemi Awolowo University, College of Health Sciences, Ile-Ife, Osun State Nigeria
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Wariri O, Jalo I, Bode-Thomas F. Discriminative ability of adiposity measures for elevated blood pressure among adolescents in a resource-constrained setting in northeast Nigeria: a cross-sectional analysis. BMC OBESITY 2018; 5:35. [PMID: 30524740 PMCID: PMC6276203 DOI: 10.1186/s40608-018-0211-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
Background Several studies examining the association and discriminative ability of adiposity measures for prehypertension and hypertension among adolescents have reported varying outcomes. We aimed to determine the discriminative ability of the Body Mass index (BMI), Waist Circumference (WC), and Waist-to-Height Ratio (WHtR) adiposity measures for elevated blood pressure (prehypertension and hypertension combined) among adolescents in Gombe, northeast Nigeria. Methods This cross-sectional study used a multi-stage sampling technique and involved 367 secondary school adolescent (10–18 years) boys and girls in Gombe Local Government Area, Gombe State, northeast Nigeria from January to September 2015. We examined and compared the associations and discriminative ability of the BMI, WC and the WHtR for elevated blood pressure using multiple logistic regression and receiver operating characteristics (ROC) curves. Area under the curves (AUC), odds ratio (OR) and 95% confidence intervals (CI) are reported. Results All three measures of adiposity were strongly and positively associated with elevated blood pressure. The BMI obesity showed the strongest association with elevated blood pressure with odds that was double the odds of WC and triple that of WHtR [adjusted OR for BMI 15.3, 95% CI (4.8–27.9)]. The discriminative ability of adiposity measures for elevated blood pressure using AUC was comparable (0.786 for BMI, vs 0.780 for WC, vs 0.761 for WHtR). Conclusion We provide evidence, here on the BMI, WC and WHtR to support the use of simple indirect measures of adiposity in evaluating adiposity-related risk including prehypertension and hypertension among Nigerian adolescents. Electronic supplementary material The online version of this article (10.1186/s40608-018-0211-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit, The Gambia at The London School of Hygience and Tropical Medicine, Fajara, The Gambia
| | - Iliya Jalo
- Department of Paediatrics, Federal Teaching Hospital (FTH), Gombe, Nigeria.,3Department of Paediatrics, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Fidelia Bode-Thomas
- 4Paediatric Cardiology Unit, Department of Paediatrics, Jos University Teaching Hospital (JUTH), Jos, Nigeria
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