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Zhang Y, Chen S, Chen L, Wu Y, Wei J, Ma T, Chen M, Ma Q, Liu J, Wang X, Xing Y, Wu L, Li W, Liu X, Guo X, Ma J, Dong Y, Zhang J. Association of SO 2/CO exposure and greenness with high blood pressure in children and adolescents: A longitudinal study in China. Front Public Health 2023; 11:1097510. [PMID: 37304113 PMCID: PMC10248062 DOI: 10.3389/fpubh.2023.1097510] [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: 11/14/2022] [Accepted: 02/06/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction We aimed to investigate the association between greenness around schools, long-term gaseous air pollution exposure (SO2 and CO), and blood pressure in children and adolescents. Methods From 2006 to 2018, a total of 219,956 Chinese children and adolescents aged 7-17 years in Beijing and Zhongshan were included in this longitudinal study. Annual average concentrations of SO2 and CO and the mean values of normalized difference vegetation index around schools were calculated. We used the generalized estimation equation model, restricted cubic spline model, and Cox model to analyze the health effects. Results Among all the subjects, 52,515 had the first onset of HBP. During the follow-up, HBP's cumulative incidence and incidence density were 23.88% and 7.72 per 100 person-year respectively. Exposures to SO2 and CO were significantly associated with SBP [β = 1.30, 95% CI: (1.26, 1.34) and 0.78 (0.75, 0.81)], DBP [β = 0.81 (0.79, 0.84) and 0.46 (0.44, 0.48)] and HBP [HR = 1.58 (1.57, 1.60) and 1.42 (1.41, 1.43)]. The risks of HBP attributed to SO2 and CO pollution would be higher in school-aged children in the low greenness group: the attributable fractions (AFs) were 26.31% and 20.04%, but only 13.90% and 17.81% in the higher greenness group. The AFs were also higher for normal-BMI children and adolescents in the low greenness group (AFs = 30.90% and 22.64%, but 14.41% and 18.65% in the high greenness group), while the AFs were not as high as expected for obese children in the low greenness group (AFs = 10.64% and 8.61%), nor was it significantly lower in the high greenness group (AFs = 9.60% and 10.72%). Discussion Greenness could alleviate the damage effects of SO2/CO exposure on the risks of HBP among children and adolescents, and the benefit is BMI sensitivity. It might offer insights for policymakers in making effective official interventions to prevent and control the prevalence of childhood HBP and the future disease burden caused by air pollution.
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Affiliation(s)
- Yi Zhang
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Shuo Chen
- Beijing Physical Examination Center, Beijing, China
| | - Li Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yu Wu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, MD, United States
| | - Tao Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Qi Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jieyu Liu
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Xinxin Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Yi Xing
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Lijuan Wu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Weiming Li
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiangtong Liu
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Xiuhua Guo
- Department of Epidemiology and Health Statistics, Capital Medical University School of Public Health, Beijing, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Jun Ma
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Yanhui Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, National Health Commission Key Laboratory of Reproductive Health, Beijing, China
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
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Iddrisu AK, Besing Karadaar I, Gurah Junior J, Ansu B, Ernest DA. Mixed effects logistic regression analysis of blood pressure among Ghanaians and associated risk factors. Sci Rep 2023; 13:7728. [PMID: 37173375 PMCID: PMC10182051 DOI: 10.1038/s41598-023-34478-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Blood pressure (BP) control is a global health issue with an increase in BP beyond the normal BP leading to different stages of hypertension in humans and hence the need to identify risk factors of BP for efficient and effective control. Multiple BP measurement have proven to provide BP readings close to the true BP status of the individual. In this study, we used multiple BP measurement data on 3809 Ghanaians to determine risk factors associated with BP. The data were obtained from World Health Organization study on Global AGEing and Adult Health. We defined high blood pressure (HBP) as [Formula: see text] 130/80 mmHg or normal as [Formula: see text] 130/80 mmHg. We provide summary statistics and also used the Chi-Square test to assess significance of association between HBP versus risk factors of HBP. The aim of this study is to identify risk factors of BP using the mixed effects logistic regression model. Data were analyzed using R version 4.2.2. The results showed that the risk of high blood pressure (HBP) decreases across the three measurement periods. There is reduced risk (OR = 0.274, 95% CI = 0.2008, 0.405) of HBP among male participants relative to female participants. The risk (OR = 2.771, 95% CI = 1.8658, 4.1145) of HBP increased by 2.771-folds among those who are 60 years and above relative to those below the age of 60 years. Those whose work involves/requires vigorous exercise has 1.631-fold increase in the risk (OR = 1.631, 95% CI = 1.1151, 2.3854) of HBP relative to those whose work does not involve vigorous exercise. There is approximately 5-folds increased in the risk (OR = 4.896, 95% CI = 1.9535, 12.2268) of among those who have ever been diagnosed with diabetes. The results also revealed high risk (OR = 1.649, 95%CI = 1.1108, 2.4486) of HBP among those who have formal education. The risk (OR = 1.009, 95% CI = 1.0044, 1.0137) of HBP increases with increasing weight and a reduced risk (OR = 0.996, 95% CI = 0.9921, 0.9993) of HBP with increasing height. We found that sad experience, either mild, moderate or severe, is associated with a reduced risk of HBP. Those who have vegetable servings at least 2 cups per day have increased risk of HBP and those who have fruits servings at least 2 cups per day is associated with a reduced risk of HBP, however this is not statistically significant. To achieve success in BP control, programs should be designed with the aim of reducing weight, educate those with formal eduction on issues relating to HBP. Those whose work requires vigorous exercise are recommended to have regular check-ups to ensure that pressure build-up in the lungs is cleared. SBP is lower for women at young age but continue to increase after menopause as their BP increase becomes salt-sensitive. Hence there is need to give more attention to menopausal women so as to improve BP. Both young and old individuals are recommended to practice regular exercise since this has shown to reduce risk of being overweight or becoming diabetic and reduces the risk of HBP at yong age and old age. Also, to improve blood pressure control, programs for management of blood pressure or hypertension should focus more short stature individuals since such people are more likely to experience HBP.
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Affiliation(s)
- Abdul-Karim Iddrisu
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana.
| | | | - Joseph Gurah Junior
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
| | - Bismark Ansu
- Department of Mathematics and ICT, St. Ambrose College of Education, Dormaa-Akwamu, Ghana
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Neves SC, Rodrigues LM, Bento PADSS, Minayo MCDS. Risk factors involved in adolescent obesity: an integrative review. CIENCIA & SAUDE COLETIVA 2021; 26:4871-4884. [PMID: 34787182 DOI: 10.1590/1413-812320212611.3.30852019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/02/2020] [Indexed: 02/04/2023] Open
Abstract
The scope of this study was to examine the risk factors for the development of obesity in adolescence. The objective was to identify risk factors for adolescent obesity by means of an Integrative Review of the Literature. The PICO strategy was used to formulate the following central line of inquiry: What are the risk factors for the development of obesity during adolescence? The VHL and EBSCOhost research databases were consulted, resulting in a selection of 25 articles for in-depth study. The phenomenon of obesity was understood as the result of biological, social, psychological, and nutritional factors. The research revealed a lack of consensus on the risks and benefits, which makes evidence-based recommendations difficult. The study identified proposals that can be implemented, such as a change in eating habits, weight control and the practice of physical exercise. Such behavioral changes can be recommended within the context of the family, schools, and health services. The review recommends prevention strategies and the recognition of school as the ideal medium for health promotion through education. From a political and social standpoint, it is necessary to challenge the prevalence of publicity of the food industry that entices adolescents to consume processed foods with high fat and sugar content.
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Affiliation(s)
- Simone Carvalho Neves
- Enfermagem Souza Marques, Fundação Técnico-Educacional Souza Marques. Av. Ernani Cardoso 335/345, Cascadura. 21310.310 Rio de Janeiro RJ Brasil.
| | | | - Paulo Alexandre de Souza São Bento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Maria Cecília de Souza Minayo
- Departamento de Estudos sobre Violência e Saúde Jorge Careli (Claves), Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Christofaro DGD, Farah BQ, Vanderlei LCM, Delfino LD, Tebar WR, Barros MVGD, Ritti-Dias RM. Analysis of different anthropometric indicators in the detection of high blood pressure in school adolescents: a cross-sectional study with 8295 adolescents. Braz J Phys Ther 2017; 22:49-54. [PMID: 29169996 PMCID: PMC5816077 DOI: 10.1016/j.bjpt.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 05/17/2017] [Accepted: 07/24/2017] [Indexed: 11/24/2022] Open
Abstract
Overweight adolescents classified in any of three anthropometric indices have more HBP. The sensitivity of the indicators was low and the specificity was high in detecting HBP. Parents must be aware that high BMI, WC or WTHR are highly associated with HBP.
Background High blood pressure is strongly associated with obesity in different populations. However, it is unclear whether different anthropometric indicators of obesity can satisfactorily predict high blood pressure in the school setting. Objectives This study evaluated the sensitivity and specificity of body mass index, waist circumference, and waist to height ratio in the detection of high blood pressure in adolescents. Methods The sample consisted of 8295 adolescents aged 10–17 years. Weight was measured using a digital scale, height with a stadiometer, and waist circumference using a tape measure. Blood pressure was measured by an automatic blood pressure measuring device. ROC curves were used for the analysis of sensitivity and specificity of the three anthropometric indices in identifying high blood pressure. Binary Logistic Regression was used to assess the association of body mass index, waist circumference, and waist to height ratio with high blood pressure. Results Low values of sensitivity were observed for body mass index (0.35), waist circumference (0.37), and waist to height ratio (0.31) and high values of specificity for body mass index (0.86), waist circumference (0.82), and waist to height ratio (0.83) in the detection of high blood pressure. An association was observed between adolescents classified with high body mass index (OR = 3.57 [95% CI = 3.10–4.10]), waist cirumference (OR = 3.24 [95% CI = 2.83–3.72]), and waist to height ratio (OR = 2.94 [95% CI = 2.54–3.40]) with high blood pressure. Conclusions Body mass index, waist circumference, and waist to height ratio presented low sensitivity to identify adolescents with high blood pressure. However, adolescents classified with high body mass index, waist circumference, and waist to height ratio demonstrated a high association of presenting high blood pressure.
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Affiliation(s)
- Diego G D Christofaro
- Universidade Estadual Paulista (UNESP), Department of Physical Education, Presidente Prudente, SP, Brazil.
| | - Breno Q Farah
- Universidade de Pernambuco (UPE), Department of Physical Education, Recife, PE, Brazil
| | - Luiz Carlos M Vanderlei
- Universidade Estadual Paulista (UNESP), Department of Physical Therapy, Presidente Prudente, SP, Brazil
| | - Leandro D Delfino
- Universidade Estadual Paulista (UNESP), Department of Physical Education, Presidente Prudente, SP, Brazil
| | - William R Tebar
- Universidade Estadual Paulista (UNESP), Department of Physical Education, Presidente Prudente, SP, Brazil
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Dong Y, Ma J, Song Y, Dong B, Wang Z, Yang Z, Wang X, Prochaska JJ. National Blood Pressure Reference for Chinese Han Children and Adolescents Aged 7 to 17 Years. Hypertension 2017; 70:897-906. [PMID: 28923902 DOI: 10.1161/hypertensionaha.117.09983] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/17/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
We sought to develop and validate a national blood pressure (BP) reference based on age, sex, and height for Chinese children. Data were obtained on 197 430 children aged 7 to 17 who participated in the Chinese National Survey on Students' Constitution and Health in 2010. BP percentiles were estimated and fitted using the lambda, mu, and sigma method and then compared with a US reference and China existing reference. In an external independent validation sample of 59 653 children aged 7 to 18 from 7 Chinese provinces in 2013, the prevalence of elevated BP was compared applying the 3 references. BP values were similar for boys and girls at the younger ages (7-13 years) and lower height percentiles, whereas higher at the older ages (14-17 years) for boys than girls. At medial height in boys and girls aged 7 to 13, the 50th, 90th, 95th, and 99th percentiles of BP for the new national reference were consistent with US reference and lower than current Chinese reference. In the independent sample, elevated BP prevalence, based on the new national reference, ranged from 7.8% to 18.5% among children aged 7 to 17, which was higher than the US reference values (4.3%-14.5%) and lower than the current Chinese reference (12.9%-25.5%) in each age group. The new national BP reference for Chinese children based on age, sex, and height from large-scale and nationally representative data seems to improve the ability for identifying Chinese hypertensive children and for stratifying them with regard to cardiovascular risk.
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Affiliation(s)
- Yanhui Dong
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Jun Ma
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.).
| | - Yi Song
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.).
| | - Bin Dong
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Zhenghe Wang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Zhaogeng Yang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Xijie Wang
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
| | - Judith J Prochaska
- From the Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China (Y.D., J.M., Y.S., B.D., Z.W., Z.Y., X.W.); and Stanford Prevention Research Center, Department of Medicine, Stanford University, CA (Y.S., J.J.P.)
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Dong B, Wang Z, Ma J. Urban-rural disparity in blood pressure among Chinese children: 1985-2010. Eur J Public Health 2015; 26:569-75. [PMID: 26715473 DOI: 10.1093/eurpub/ckv239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Understanding the urban-rural gap in childhood blood pressure (BP) is crucial to alleviate the urban-rural disparity in burden of hypertension in the future. This study investigated trends in urban-rural BP disparity and the influence of body mass index among Chinese children between 1985 and 2010. METHODS Data included 1 010 153 children aged 8-17 years enrolled in the Chinese National Survey on Students' Constitution and Health, a successive national cross-sectional survey. High BP was defined according to age-sex- and height-specific 95th percentile. Multi-variable linear and logistic regression models were used to assess the urban-rural BP differentials. RESULTS Although urban children had greater prevalence of overweight and obesity than rural counterparts, rural children revealed higher levels of BP across the consecutive 25-year periods. The urban-rural disparity in prevalence of high systolic BP decreased from 2.3 (95% confidence interval: 2.3, 2.6) % to 0.2 (-0.1, 0.4) % in boys and 3.7 (3.5, 4.0) % to 0.6 (0.3, 0.8) % in girls between 1985 and 2010 after adjusting for confounding factors. Further adjustment of body mass index did not change the urban-rural disparity and its trend. The similar results were also observed for diastolic BP. CONCLUSIONS Despite the urban-rural disparity in BP decreased between 1985 and 2010, rural children constantly showed higher BP levels than their urban counterparts. Since these differentials in BP cannot be explained by obesity, study of other potential factors could provide further opportunity to bridge this gap.
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Affiliation(s)
- Bin Dong
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Zhiqiang Wang
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China 2 Centre for Chronic Disease, School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jun Ma
- 1 Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, People's Republic of China
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Tian Y, Wu H. Prevalence of obesity among students aged 6 to 12 in China: a meta-analysis. Food Nutr Res 2015; 59:25747. [PMID: 26689312 PMCID: PMC4685292 DOI: 10.3402/fnr.v59.25747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 08/27/2015] [Accepted: 09/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background In recent years, obesity has become a major public health problem worldwide. It has been estimated that 8% of children are obese. This study evaluates the overall prevalence of obesity in primary students in recent years. Methods Publications from 2011 and 2015 on the obesity prevalence among primary school students aged 6 to 12 in China were retrieved from the databases PubMed and Wanfang Data. Obesity was defined using the International Obesity Task Force standard body mass index cutoff points established for children. MetaAnalyst 3.13 software was used to calculate the total prevalence of obesity among primary school students in recent years. Results After evaluation of the quality of the articles, 14 papers were finally included in our study. The pooled prevalence of obesity in students aged 6 to 12 is 10.2% (95% CI: 7.1–14.6%). Conclusion Our results indicate that obesity is prevalent in students aged 6 to 12 in China. We believe that appropriate measures should be taken to control this situation.
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Affiliation(s)
- Yue Tian
- Department of Pediatrics, Yantaishan Hospital (affiliated with Taishan Medical College), Yantai, China
| | - Haixia Wu
- Department of Pediatrics, Yantaishan Hospital (affiliated with Taishan Medical College), Yantai, China
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