1
|
Roy S, Malik M, Basu S. Hypertension care cascade and their determinants among older adolescents in India: evidence from a nationally representative cross-sectional survey. J Hum Hypertens 2024:10.1038/s41371-024-00940-3. [PMID: 39085385 DOI: 10.1038/s41371-024-00940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
Adolescent hypertension in India is an emergent public health concern with lack of programmatic focus on regular screening amongst both individuals and healthcare providers. This study was conducted to assess the hypertension care cascade (prevalence, awareness, treatment and control status of hypertension) from nationally representative data. We used data from the demographic and health surveillance (DHS) comprising India's National Family Health Survey Fifth Round (2019-2021). The prevalence of hypertension among 204,054 older adolescents (15-19 years) was 5.08% (95% CI: 4.94-5.23%) wherein 42.26% (95% CI: 40.69-43.64%) were aware of their condition, 43.70% (95% CI: 41.73-45.70%) of those aware were receiving treatment, and 85.88% (95% CI: 83.83-87.71%) of those on treatment achieved blood pressure control. Overall, there were nearly 60% newly diagnosed hypertension cases detected on screening. Females had significantly lower odds, while those with diabetes and higher waist-hip ratio had significantly higher odds of having hypertension. The awareness of their hypertensive status was higher among females and rural residents, while it was lower among adolescents that were obese and tobacco smokers. Improved blood pressure control was associated with a lower waist-to-hip ratio. In conclusion, nearly five in every hundred older adolescents in India are clinically hypertensive with significantly higher odds linked with obesity and male gender. Awareness and utilization of antihypertensive treatment was lower than the classical rule of halves signifying deficiencies in hypertension screening and management strategies for older adolescents within the existing public health policy framework.
Collapse
Affiliation(s)
- Shubhanjali Roy
- Indian Institute of Public Health- Delhi, Public Health Foundation of India, New Delhi, India
| | - Mansi Malik
- Indian Institute of Public Health- Delhi, Public Health Foundation of India, New Delhi, India
| | - Saurav Basu
- Indian Institute of Public Health- Delhi, Public Health Foundation of India, New Delhi, India.
| |
Collapse
|
2
|
Cuda SE, Kharofa R, Williams DR, O'Hara V, Conroy R, Karjoo S, Paisley J, Censani M, Browne NT. Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100031. [PMID: 37990723 PMCID: PMC10662000 DOI: 10.1016/j.obpill.2022.100031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. This CPS will be followed by a companion CPS covering further comorbidities, including genetics and social consequences related to overweight and obesity. These CPSs are intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 95th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children. It provides clinical information regarding identifying and treating metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children over the 95th percentile of weight/height for age. Conclusions This OMA clinical practice statement details metabolic, behavioral health, and disordered eating comorbidities associated with obesity in children and provides an overview of current recommendations. These recommendations lay out a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
Collapse
Affiliation(s)
- Suzanne E. Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145, San Antonio, TX, 78218, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
| | - Valerie O'Hara
- WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Rushika Conroy
- Division of Pediatric Endocrinology, Baystate Children's Hospital Subspecialty Center, 50 Wason Avenue, Springfield, MA, 01107, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital, Pediatric Gastroenterology, 501 6th Ave S St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care, 98 Elm Street, Lawrenceburg, IN, 47025-2048, USA
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | | |
Collapse
|
3
|
Liu H, Zhao H, Che J, Yao W. Naringenin Protects against Hypertension by Regulating Lipid Disorder and Oxidative Stress in a Rat Model. Kidney Blood Press Res 2022; 47:423-432. [PMID: 35354142 DOI: 10.1159/000524172] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Naringenin, a natural resource-derived flavanone, exhibits a plethora of pharmacological properties. The present study aimed to investigate the effects of naringenin on obesity-associated hypertension and its underlying mechanism. METHODS Obesity-associated hypertension rat model was established with a high-fat diet (HFD) and was administrated with naringenin (25, 50, 100 mg/kg). Body and fat weights were recorded and blood pressure was measured. Serum lipid parameters (cholesterol, low-density lipoprotein [LDL], high-density lipoprotein [HDL], and triglycerides), oxidative stress biomarkers (malondialdehyde [MDA], superoxide dismutase [SOD], nitrite oxide [NO], and glutathione [GSH]), and adipocytokines (leptin and adiponectin) were determined. The expressions of signal transducer and activator of transcription (STAT) 3 were determined by using Western blotting. RESULTS Treatment with naringenin (100 mg/kg) reduced body and fat weight in HFD-induced rats. Besides, treatment with naringenin (50 and 100 mg/kg) reduced blood pressure and regulated lipid parameters by decreasing cholesterol, triglycerides, and LDL and increasing HDL. Treatment with naringenin (50 and 100 mg/kg) reduced serum MDA and NO, whereas it increased serum SOD and GSH. Furthermore, treatment with naringenin (50 and 100 mg/kg) regulated adipocytokines and decreased the phosphorylation of STAT3. CONCLUSION Naringenin ameliorates obesity-associated hypertension by regulating lipid disorder and oxidative stress.
Collapse
Affiliation(s)
- Hui Liu
- Department of Cardiovascular Medicine, Tianjin Hospital, Tianjin, China
| | - Hui Zhao
- Department of Cardiovascular Medicine, Tianjin Hospital, Tianjin, China
| | - Jingjin Che
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Weijie Yao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| |
Collapse
|
4
|
Binns HJ, Joseph M, Ariza AJ, Cuda SE, Skinner AC, Xu H, Tucker JM, Hampl SE, Santos M, Mayo S, King EC, Kirk S. Elevated blood pressure in youth in pediatric weight management programs in the Pediatric Obesity Weight Evaluation Registry (POWER). J Clin Hypertens (Greenwich) 2022; 24:122-130. [PMID: 35099099 PMCID: PMC8845448 DOI: 10.1111/jch.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 02/01/2023]
Abstract
Blood pressure (BP) assessment and management are important aspects of care for youth with obesity. This study evaluates data of youth with obesity seeking care at 35 pediatric weight management (PWM) programs enrolled in the Pediatric Obesity Weight Evaluation Registry (POWER). Data obtained at a first clinical visit for youth aged 3–17 years were evaluated to: (1) assess prevalence of BP above the normal range (high BP); and (2) identify characteristics associated with having high BP status. Weight status was evaluated using percentage of the 95th percentile for body mass index (%BMIp95); %BMIp95 was used to group youth by obesity class (class 1, 100% to < 120% %BMIp95; class 2, 120% to < 140% %BMIp95; class 3, ≥140% %BMIp95; class 2 and class 3 are considered severe obesity). Logistic regression evaluated associations with high BP. Data of 7943 patients were analyzed. Patients were: mean 11.7 (SD 3.3) years; 54% female; 19% Black non‐Hispanic, 32% Hispanic, 39% White non‐Hispanic; mean %BMIp95 137% (SD 25). Overall, 48.9% had high BP at the baseline visit, including 60.0% of youth with class 3 obesity, 45.9% with class 2 obesity, and 37.7% with class 1 obesity. Having high BP was positively associated with severe obesity, older age (15–17 years), and being male. Nearly half of treatment‐seeking youth with obesity presented for PWM care with high BP making assessment and management of BP a key area of focus for PWM programs.
Collapse
Affiliation(s)
- Helen J Binns
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Madeline Joseph
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Adolfo J Ariza
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Suzanne E Cuda
- Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, Texas, USA
| | - Asheley C Skinner
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Haolin Xu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jared M Tucker
- Helen DeVos Children's Hospital, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| | - Sarah E Hampl
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | | | - Shawyntee Mayo
- College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Eileen C King
- Pediatrics, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Shelley Kirk
- Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.,The Heart Institute, Center for Better Health and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | -
- Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
5
|
A Multilayer Perceptron Neural Network Model to Classify Hypertension in Adolescents Using Anthropometric Measurements: A Cross-Sectional Study in Sarawak, Malaysia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2794888. [PMID: 34917164 PMCID: PMC8670914 DOI: 10.1155/2021/2794888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/28/2021] [Accepted: 11/13/2021] [Indexed: 11/21/2022]
Abstract
This study outlines and developed a multilayer perceptron (MLP) neural network model for adolescent hypertension classification focusing on the use of simple anthropometric and sociodemographic data collected from a cross-sectional research study in Sarawak, Malaysia. Among the 2,461 data collected, 741 were hypertensive (30.1%) and 1720 were normal (69.9%). During the data gathering process, eleven anthropometric measurements and sociodemographic data were collected. The variable selection procedure in the methodology proposed selected five parameters: weight, weight-to-height ratio (WHtR), age, sex, and ethnicity, as the input of the network model. The developed MLP model with a single hidden layer of 50 hidden neurons managed to achieve a sensitivity of 0.41, specificity of 0.91, precision of 0.65, F-score of 0.50, accuracy of 0.76, and Area Under the Receiver Operating Characteristic (ROC) Curve (AUC) of 0.75 using the imbalanced data set. Analyzing the performance metrics obtained from the training, validation and testing data sets show that the developed network model is well-generalized. Using Bayes' Theorem, an adolescent classified as hypertensive using this created model has a 66.2% likelihood of having hypertension in the Sarawak adolescent population, which has a hypertension prevalence of 30.1%. When the prevalence of hypertension in the Sarawak population was increased to 50%, the developed model could predict an adolescent having hypertension with an 82.0% chance, whereas when the prevalence of hypertension was reduced to 10%, the developed model could only predict true positive hypertension with a 33.6% chance. With the sensitivity of the model increasing to 65% and 90% while retaining a specificity of 91%, the true positivity of an adolescent being hypertension would be 75.7% and 81.2%, respectively, according to Bayes' Theorem. The findings show that simple anthropometric measurements paired with sociodemographic data are feasible to be used to classify hypertension in adolescents using the developed MLP model in Sarawak adolescent population with modest hypertension prevalence. However, a model with higher sensitivity and specificity is required for better positive hypertension predictive value when the prevalence is low. We conclude that the developed classification model could serve as a quick and easy preliminary warning tool for screening high-risk adolescents of developing hypertension.
Collapse
|
6
|
Causative Mechanisms of Childhood and Adolescent Obesity Leading to Adult Cardiometabolic Disease: A Literature Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112311565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The past few decades have shown a worrisome increase in the prevalence of obesity and its related illnesses. This increasing burden has a noteworthy impact on overall worldwide mortality and morbidity, with significant economic implications as well. The same trend is apparent regarding pediatric obesity. This is a particularly concerning aspect when considering the well-established link between cardiovascular disease and obesity, and the fact that childhood obesity frequently leads to adult obesity. Moreover, most obese adults have a history of excess weight starting in childhood. In addition, given the cumulative character of both time and severity of exposure to obesity as a risk factor for associated diseases, the repercussions of obesity prevalence and related morbidity could be exponential in time. The purpose of this review is to outline key aspects regarding the current knowledge on childhood and adolescent obesity as a cardiometabolic risk factor, as well as the most common etiological pathways involved in the development of weight excess and associated cardiovascular and metabolic diseases.
Collapse
|
7
|
Meitei SY, Pao PSV, Devi TC, Sharma BS, Konjengbam H. Body adiposity measures and risk of adolescent hypertension among the postpubescents Northeast India. Am J Hum Biol 2021; 34:e23675. [PMID: 34499782 DOI: 10.1002/ajhb.23675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The present study attempts to associate and predict adolescent hypertension in Northeast India through body adiposity measures. METHOD A total of 728 adolescents aged 15 years and above were included in the present study after consent. Blood pressure and related anthropometric data were collected. The prevalence rate was calculated. Significant tests and correlation analyses were conducted between the blood pressure parameters and anthropometric body adiposity measures. The odds ratio (OR) was also calculated to assess the likelihood of risks. The receiver operating characteristic (ROC) curve analysis was performed to find the measured parameters' predictive cut-off values. RESULTS The prevalence of adolescent hypertension is 29.12%, and elevated blood pressure is 20.47%. Boys are more hypertensive than girls. Obese adolescents are more prone to hypertension. Overweight, obese, and abdominal volume index (AVI) has 2.31, 5.15, and 3.41 OR to develop hypertension significantly, irrespective of gender. Among the boys, waist circumference (WC), AVI, and waist to height ratio (WHtR) significantly correlate with hypertension at adjusted for age; they are better predictors with area under curve (AUC) value reach 0.7. Among the females, the BMI reaches AUC 0.7, making it a better assessment for hypertension. CONCLUSION The study highlights the concerns of adolescent hypertension among Northeast Indian adolescents, which needs attention. More studies in different regions must be conducted to understand the problem's crux to enable health policymakers to promote adolescent health.
Collapse
Affiliation(s)
| | - P S Vaveine Pao
- Department of Anthropology, Manipur University, Imphal, Manipur, India
| | | | | | - Henry Konjengbam
- Department of Anthropology, Manipur University, Imphal, Manipur, India
| |
Collapse
|
8
|
Souza LV, de Almeida SS, De Meneck F, Thomazini F, Araujo RC, Franco do MC. Polymorphism of the bradykinin type 2 receptor gene modulates blood pressure profile and microvascular function in prepubescent children. Peptides 2021; 137:170491. [PMID: 33412234 DOI: 10.1016/j.peptides.2020.170491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
Previous reports reveal that +9/-9 polymorphism of the bradykinin B2 receptor (BDKRB2) is suggestive of cardiometabolic diseases. The aim of this study was to examine the impact of BDKRB2 + 9/-9 polymorphism genotypes on the blood pressure parameters and microvascular function in prepubescent children. We screened for BDKRB2 + 9/-9 polymorphism in the DNA of 145 children (86 boys and 59 girls), and its association with body composition, blood pressure levels, biochemical parameters, and endothelial function was determined. No significant association of the BDKRB2 genotypes with gender (P=0.377), race (P=0.949) or family history of cardiovascular disease (CVD) (P=0.858) was observed. Moreover, we did not identify any interaction between BDKRB2 genotypes with a phenotype of obesity (P=0.144). Children carrying the +9/+9 genotype exhibited a significant linear trend with higher levels of systolic blood pressure and pulse pressure (P<0.001). Moreover, the presence of +9 allele resulted in a decrease of reactive hyperemia index, showing a decreasing linear trend from -9/-9 to +9/+9, wherein this parameter of endothelial function was the lowest in the +9/+9 children, intermediate in the +9/-9 children, and the highest in the -9/-9 children (P<0.001). There was a significant inverse correlation between reactive hyperemia index and systolic blood pressure (r= - 0.348, P< 0.001) and pulse pressure (r= - 0.399, P< 0.001). Our findings indicate that the +9/+9 BDKRB2 genotype was associated with high blood pressure and microvascular dysfunction in prepubescent Brazilian children.
Collapse
Affiliation(s)
- Livia Victorino Souza
- Division of Nephrology, Medicine Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Franciele De Meneck
- Division of Nephrology, Medicine Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fernanda Thomazini
- Division of Translational Medicine, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Ronaldo Carvalho Araujo
- Biophysical Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Carmo Franco do
- Division of Nephrology, Medicine Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
| |
Collapse
|
9
|
Calcaterra V, Regalbuto C, Porri D, Pelizzo G, Mazzon E, Vinci F, Zuccotti G, Fabiano V, Cena H. Inflammation in Obesity-Related Complications in Children: The Protective Effect of Diet and Its Potential Role as a Therapeutic Agent. Biomolecules 2020; 10:E1324. [PMID: 32947869 PMCID: PMC7564478 DOI: 10.3390/biom10091324] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Obesity is a growing health problem in both children and adults, impairing physical and mental state and impacting health care system costs in both developed and developing countries. It is well-known that individuals with excessive weight gain frequently develop obesity-related complications, which are mainly known as Non-Communicable Diseases (NCDs), including cardiovascular disease, type 2 diabetes mellitus, metabolic syndrome, non-alcoholic fatty liver disease, hypertension, hyperlipidemia and many other risk factors proven to be associated with chronic inflammation, causing disability and reduced life expectancy. This review aims to present and discuss complications related to inflammation in pediatric obesity, the critical role of nutrition and diet in obesity-comorbidity prevention and treatment, and the impact of lifestyle. Appropriate early dietary intervention for the management of pediatric overweight and obesity is recommended for overall healthy growth and prevention of comorbidities in adulthood.
Collapse
Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
| | - Corrado Regalbuto
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Debora Porri
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (D.P.); (H.C.)
| | - Gloria Pelizzo
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
- Pediatric Surgery Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy
| | - Emanuela Mazzon
- IRCCS Centro Neurolesi “Bonino-Pulejo”, 98124 Messina, Italy;
| | - Federica Vinci
- Pediatric Unit, Fond. IRCCS Policlinico S. Matteo and University of Pavia, 27100 Pavia, Italy; (C.R.); (F.V.)
| | - Gianvincenzo Zuccotti
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
| | - Valentina Fabiano
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20153 Milan, Italy; (G.Z.); (V.F.)
- “L. Sacco” Department of Biomedical and Clinical Science, University of Milan, 20153 Milan, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy; (D.P.); (H.C.)
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
| |
Collapse
|
10
|
Miranda JO, Cerqueira RJ, Barros H, Areias JC. Maternal Diabetes Mellitus as a Risk Factor for High Blood Pressure in Late Childhood. Hypertension 2019; 73:e1-e7. [PMID: 30571550 DOI: 10.1161/hypertensionaha.118.11761] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intrauterine fetal conditions can have lifelong cardiovascular effects. The impact of maternal diabetes mellitus on children's cardiovascular profile is not well established. The goal of this study was to explore the association between maternal diabetes mellitus and offspring's blood pressure (BP) ≤10 years of age. Generation XXI is a prospective birth cohort, which enrolled 8301 mother-offspring pairs, including 586 (7.1%) children of diabetic mothers. The associations between maternal diabetes mellitus and BP at 4, 7, and 10 years of age was modeled using linear regression. A mixed-effects model was built to assess differences in BP variation over time. Path analysis was used to quantify effects of potential mediators. Maternal diabetes mellitus was associated with higher BP in offspring at the age of 10 (systolic: β, 1.48; 95% CI, 0.36-2.59; and diastolic: β, 0.86; 95% CI, 0.05-1.71). This association was independent of maternal perinatal characteristics, and it was mediated by child's body mass index and, to a lesser extent, by gestational age, type of birth, and birth weight (indirect effect proportion, 73%). No significant differences in BP were found at 4 and 7 years of age. Longitudinal analysis showed an accelerated systolic BP increase on maternal diabetes mellitus group (β, 1.16; 95% CI, 0.03-2.28). These finding were especially relevant in males, suggesting sex differences in the mechanisms of BP prenatal programing. Our results provide further evidence that maternal diabetes mellitus is associated with high BP late in childhood, demonstrating a significant role of child's body mass in the pathway of this association.
Collapse
Affiliation(s)
- Joana Oliveira Miranda
- From the Departamento de Cardiologia Pediátrica (J.O.M., J.C.A.), Centro Hospitalar São João, Porto, Portugal.,Departamento de Cirurgia e Fisiologia (J.O.M., R.J.C.), Faculdade de Medicina da Universidade do Porto, Portugal.,Unidade de Investigação Cardiovascular (J.O.M., R.J.C.), Universidade do Porto, Portugal
| | - Rui João Cerqueira
- Departamento de Cirurgia Cardiotorácica (R.J.C.), Centro Hospitalar São João, Porto, Portugal.,Departamento de Cirurgia e Fisiologia (J.O.M., R.J.C.), Faculdade de Medicina da Universidade do Porto, Portugal.,Unidade de Investigação Cardiovascular (J.O.M., R.J.C.), Universidade do Porto, Portugal
| | - Henrique Barros
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica (H.B.), Faculdade de Medicina da Universidade do Porto, Portugal.,EPIUnit - Instituto de Saúde Pública (H.B.), Universidade do Porto, Portugal
| | - José Carlos Areias
- From the Departamento de Cardiologia Pediátrica (J.O.M., J.C.A.), Centro Hospitalar São João, Porto, Portugal.,Departamento de Ginecologia-Obstetrícia e Pediatria (J.C.A.), Faculdade de Medicina da Universidade do Porto, Portugal
| |
Collapse
|
11
|
Rose K, Grant-Kels JM. The Meanings of "Pediatric Drug Development". Ther Innov Regul Sci 2019; 53:767-774. [PMID: 30526039 DOI: 10.1177/2168479018812060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/18/2018] [Indexed: 07/09/2024]
Abstract
Pediatric drug development (PDD) became an industry goal when the Food and Drug Administration (FDA) granted patent extensions. This was later expanded to obligations for pediatric studies and to the European Medicines Agency's (EMA's) strict pediatric investigation plans (PIPs). Industry now sponsors many often international studies in young patients that are difficult or impossible to recruit. PDD's intellectual foundations characterize children as "therapeutic orphans," allegedly discriminated in drug treatment and development. While toxicities occured in newborns, demanding separate efficacy and safety (E&S) studies in all age groups is wasteful and reflects hidden conflicts of interest. The American Academy of Pediatrics (AAP) successfully procured pediatric research funds; the FDA dislikes pediatric off-label use and envisions labels as instructions for physicians. Pediatricians have continuously improved child health care by careful use of available drugs. Instead of physiologically defining children vis-à-vis drug treatment, the FDA defines children as ≤16 years old, offering convincing pretense for the need for mostly senseless "pediatric" studies in young adults, adolescents, and children. Although these studies may help advance pediatric academic careers, they do not improve pediatric health care. The EMA defines children as <18 years old and demands even more senseless and potentially harmful "pediatric" studies. Young patients need pharmacokinetic/pharmacodynamic and dose finding, but not separate E&S, studies. Institutional review boards and ethics committees should suspend or reject questionable FDA/EMA-demanded "pediatric" studies. Industry and science need repositioning towards "PDD"; US/EU pediatric laws need revision. We hope this will not take decades.
Collapse
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Riehen, BS, Switzerland
| | | |
Collapse
|
12
|
Rose K, Grant-Kels JM. Pediatric melanoma-The whole (conflicts of interest) story. Int J Womens Dermatol 2019; 5:110-115. [PMID: 30997384 PMCID: PMC6451736 DOI: 10.1016/j.ijwd.2018.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/25/2018] [Accepted: 10/09/2018] [Indexed: 01/13/2023] Open
Affiliation(s)
- Klaus Rose
- klausrose Consulting, Riehen, Switzerland
| | | |
Collapse
|
13
|
Benestad B, Júlíusson PB, Siegfried W, Lekhal S, Småstuen MC, Hertel JK, Agosti F, Marazzi N, Hjelmesæth J, Sartorio A. Cardiometabolic risk factors differ among adolescents with obesity in three European countries - a cross-sectional study. Acta Paediatr 2019; 108:493-501. [PMID: 30118191 PMCID: PMC6585823 DOI: 10.1111/apa.14542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/20/2022]
Abstract
Aim We aimed to compare modifiable cardiometabolic risk factors among treatment‐seeking adolescents with obesity in Italy, Germany and Norway. Methods This retrospective, registry‐based, cross‐sectional cohort study included 2,327 (59% girls) 12–18 year‐old adolescents with obesity from three tertiary care outpatient clinics in Europe, between 1999 and 2015. The prevalence of cardiometabolic risk factors was compared between clinics, and multivariate logistic regression models including gender, age, waist circumference and body mass index were used to assess the associations between population and cardiometabolic risk. Results In total, 1,396 adolescents (60% girls) from Italy, 654 (58% girls) from Germany and 277 (51% girls) from Norway were included. The mean ± SD age was 15.2 ± 1.6 years, body mass index 38.8 ± 6.5 kg/m2 and body mass index standard deviation score 3.21 ± 0.43. The prevalence of elevated nonhigh‐density lipoprotein‐cholesterol in Norway, Germany and Italy was 60%, 54% and 45%, while the prevalence of high systolic or diastolic blood pressure (≥130 or ≥85 mmHg) were 15%, 46% and 66%, respectively. Conclusion Cardiometabolic risk factors among treatment‐seeking adolescents with obesity from Italy, Germany and Norway differed across the populations in this study, which might imply that preventive clinical work should reflect such differences.
Collapse
Affiliation(s)
- Beate Benestad
- The Morbid Obesity Centre (MOC) Department of Medicine Vestfold Hospital Trust Tønsberg Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Pétur B. Júlíusson
- The Morbid Obesity Centre (MOC) Department of Medicine Vestfold Hospital Trust Tønsberg Norway
- Department of Clinical Science University of Bergen Bergen Norway
| | | | - Samira Lekhal
- The Morbid Obesity Centre (MOC) Department of Medicine Vestfold Hospital Trust Tønsberg Norway
| | | | - Jens Kristoffer Hertel
- The Morbid Obesity Centre (MOC) Department of Medicine Vestfold Hospital Trust Tønsberg Norway
| | - Fiorenza Agosti
- Istituto Auxologico Italiano, IRCCS Division of Metabolic Diseases and Auxology Experimental Laboratory for Auxo‐endocrinological Research, Research Center for Growth Disorders Verbania and Milan Italy
| | - Nicoletta Marazzi
- Istituto Auxologico Italiano, IRCCS Division of Metabolic Diseases and Auxology Experimental Laboratory for Auxo‐endocrinological Research, Research Center for Growth Disorders Verbania and Milan Italy
| | - Jøran Hjelmesæth
- The Morbid Obesity Centre (MOC) Department of Medicine Vestfold Hospital Trust Tønsberg Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS Division of Metabolic Diseases and Auxology Experimental Laboratory for Auxo‐endocrinological Research, Research Center for Growth Disorders Verbania and Milan Italy
| |
Collapse
|
14
|
Mazoteras-Pardo V, Becerro-De-Bengoa-Vallejo R, Losa-Iglesias ME, López-López D, Palomo-López P, Rodríguez-Sanz D, Calvo-Lobo C. The QardioArm Blood Pressure App for Self-Measurement in an Obese Population: Validation Study Using the European Society of Hypertension International Protocol Revision 2010. JMIR Mhealth Uhealth 2018; 6:e11632. [PMID: 30361193 PMCID: PMC6229517 DOI: 10.2196/11632] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/16/2023] Open
Abstract
Background Obesity and high blood pressure (HBP) pose high cardiovascular risks, and they are frequent causes of cardiovascular disease. Objective The aim of this study was to validate the mobile app QardioArm for high blood pressure monitoring in obese subjects (body mass index ≥30 kg/m2) according to guidelines in the European Society of Hypertension-International Protocol 2 (ESH-IP2). Methods We recruited 33 obese subjects and measured their blood pressure using QardioArm (test device) and Omron M3 Intellisense (Omron Healthcare, Kyoto, Japan; standard device). We compared systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) according to the ESH-IP2. Results A total of 95 of 99 differences for SBP and 91 of 99 for DBP displayed absolute differences within 10 mm Hg. A total of 98 of 99 differences for SBP and 98 of 99 for DBP exhibited absolute differences within 15 mm Hg. This result satisfied requirements for part 1 of the ESH-IP2. A total of 27 out of 33 individuals for SBP and 30 out of 33 individuals for DBP had a minimum of 2 of 3 comparisons within 5 mm Hg difference. None of the subjects had 3 differences outside 5 mm Hg for SBP and DBP, satisfying part 2 of the ESH-IP2. For HR measurements, a total of 90 of 99 differences had absolute differences within 3 beats per minute (bpm), and a total of 94 or 99 differences had absolute differences within 5 bpm. A total of 98 of 99 differences had absolute differences within 8 bpm. Therefore, the test device satisfied part 1 of ESH-IP2 criteria for HR. For part 2 of ESH-IP2, 31 of 33 individuals had a minimum of 2 of 3 comparisons within 3 bpm difference for HR. Only 1 of 33 subjects had 3 differences outside 3 bpm. Conclusions To the best of our knowledge, this was the first study to show that an app that measures blood pressure and HR meets the requirements of the ESH-IP2 in an obese population. We believe the ESH-IP2 should publish explicit criteria for validation of blood pressure devices in specific populations.
Collapse
Affiliation(s)
- Victoria Mazoteras-Pardo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | | | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.,Faculty of Sports, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - César Calvo-Lobo
- Institute of Biomedicine, Department of Nursing and Physical Therapy, Faculty of Health Sciences, Universidad de León, Ponferrada, Spain
| |
Collapse
|
15
|
Lopes S, Mesquita-Bastos J, Alves AJ, Ribeiro F. Exercise as a tool for hypertension and resistant hypertension management: current insights. Integr Blood Press Control 2018; 11:65-71. [PMID: 30288097 PMCID: PMC6159802 DOI: 10.2147/ibpc.s136028] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although there has been an observed progress in the treatment of hypertension, its prevalence remains elevated and constitutes a leading cause of cardiovascular disease development. Resistant hypertension is a challenge for clinicians, as the available treatment options have reduced success. Physical activity and exercise training play an important role in the management of blood pressure. The importance of physical activity and exercise training as part of a comprehensive lifestyle intervention is acknowledged by several professional organizations in their recommendations/guidelines for the management of arterial hypertension. Aerobic exercise, dynamic resistance exercise, and concurrent training - the combination of dynamic resistance and aerobic exercise training in the same exercise session or on separate days - has been demonstrated to reduce blood pressure and help in the management of hypertension. The present review draws attention to the importance of exercise training in the management of blood pressure in both hypertension and resistant hypertension individuals.
Collapse
Affiliation(s)
- Susana Lopes
- School of Health Sciences, University of Aveiro, Aveiro, Portugal,
- Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal,
| | - José Mesquita-Bastos
- School of Health Sciences, University of Aveiro, Aveiro, Portugal,
- Cardiology Department, Hospital Infante D. Pedro, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Alberto J Alves
- Research Center in Sports Sciences, Health and Human Development, CIDESD, University Institute of Maia, Maia, Portugal
| | - Fernando Ribeiro
- School of Health Sciences, University of Aveiro, Aveiro, Portugal,
- Institute of Biomedicine - iBiMED, University of Aveiro, Aveiro, Portugal,
| |
Collapse
|
16
|
Cuda SE, Censani M. Pediatric Obesity Algorithm: A Practical Approach to Obesity Diagnosis and Management. Front Pediatr 2018; 6:431. [PMID: 30729102 PMCID: PMC6351475 DOI: 10.3389/fped.2018.00431] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 12/24/2018] [Indexed: 02/02/2023] Open
Abstract
Childhood obesity is a growing global health problem. Despite the highest rates of childhood obesity in the United States and other developed countries over the last 30 years, there is still no clear treatment strategy. Practitioners often do not know where to turn to find guidance on managing the nearly one third of their population who present for medical care either with obesity that coexists with other medical problems or because of obesity. The Pediatric Obesity Algorithm is an evidence based roadmap for the diagnosis and management of children with obesity. In this article, we summarize topics from the Pediatric Obesity Algorithm pertaining to pediatric obesity diagnosis, evaluation, and management including assessment, differential diagnosis, review of systems, diagnostic work up, physical exam, age specific management, comorbidities, use of medications and surgery, and medication associated weight gain. Identifying and treating children with obesity as early as possible is important, as is identifying comorbid conditions. Earlier and more comprehensive management through resources such as the Pediatric Obesity Algorithm serve to help guide health care practitioners with a practical and evidence based approach to the diagnosis and management of children with obesity, and provide families with the tools needed for a healthy future.
Collapse
Affiliation(s)
- Suzanne E Cuda
- Department of Pediatrics, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Marisa Censani
- Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, United States
| |
Collapse
|