Waist Circumference is Associated with Blood Pressure in Children with Normal Body Mass Index: A Cross-Sectional Analysis of 3,417 School Children

Effect of changes in body mass index and waist-to-height ratio on blood pressure in 11- to 13-year-old children: a prospective population study

BACKGROUND

Existing evidence about associations between change in body mass index (BMI) and waist-to-height ratio (WHtR) change and high blood pressure are relatively limited.

AIMS

We aimed to investigate the associations of general overweight (based on BMI) and abdominal obesity (based on WHtR) change with high blood pressure in Chinese children.

SUBJECTS AND METHODS

A school-based cohort study in Ningbo region (China) was conducted among children with baseline evaluations in October 2016 with follow-up two years later. A total of 1432 children aged 11-13 years participated in this study.

RESULTS

Our results showed that a change from normal BMI or WHtR to overweight or abdominal obesity in children was associated with high blood pressure (adjusted odds ratio (AOR), 2.62; p<0.05 or AOR, 2.79; p<0.05, respectively). In addition, an increased risk of high blood pressure was observed in children who maintained overweight or abdominal obesity (AOR, 1.67; p<0.05 or AOR, 1.69; p<0.05, respectively), but not in children who experienced remission to non-excess weight. Interestingly, children who increased BMI or WHtR had greater impact on SBP than on DBP.

CONCLUSION

The 2-year longitudinal study indicated that general overweight or abdominal obesity can predict the risk factor of high blood pressure in children. However, children who remitted to non-excess weight did not exhibit an increased risk of high blood pressure.

Salivary Neurotrophins Brain-Derived Neurotrophic Factor and Nerve Growth Factor Associated with Childhood Obesity: A Multiplex Magnetic Luminescence Analysis

Obesity is linked with higher inflammatory markers and is characterized by chronic low-grade inflammation. Neurotrophins brain-derived neurotrophic factor (BDNF) and β-nerve growth factor (β-NGF), in addition to their neuronal functions, act on several immune cells and have been recently designated as metabokines due to their regulatory role in energy homeostasis and food intake. The current study evaluates the salivary BDNF and β-NGF and their association with anthropometric measurement, blood pressure, and salivary insulin in children. Anthropometric measurements and saliva samples were obtained from 76 children, aged 6–10 years. Multiplex analysis was carried out for the salivary analysis of BDNF, NGF, and insulin by human magnetic Luminex performance assay. Statistical analysis was performed to analyze the best fit diagnostic value for biomarkers and the relationship of the neurotrophic levels of BDNF and NGF with obesity measures and blood pressure. Salivary BDNF and β-NGF showed a significantly higher concentration in obese children than normal-weight children. Both neurotrophins are positively associated with obesity anthropometric measures, blood pressure, and salivary insulin. Multinominal regression analysis reported a significant association between salivary BDNF, β-NGF, insulin, and systolic pressure adjusted for age, gender, income, and maternal education. The salivary concentration of BDNF and NGF was higher in obese children, and it is positively associated with anthropometric measures, suggesting that neurotrophins can be used as a non-invasive predictor of obesity-related complications in children.

Association between body composition and blood pressure in normal-weight Chinese children and adolescents

Background

The aim of this study was to assess the associations of body fat distribution and lean body mass (LBM) with blood pressure (BP) in normal-weight Chinese children and adolescents.

Methods

A total of 898 normal-weight Chinese children and adolescents, aged 10–18 years, were included this cross-sectional study via a cluster sampling method. The bioelectrical impedance analysis (BIA) was used to measure body composition. The participants were measured for blood pressure (BP) using a calibrated electronic sphygmomanometer according to the standard method by the "American Hypertension Education Project Working Group".

Results

Body composition was related to abnormal BP in normal-weight children and adolescents. After the model adjusted for age, smoking, and drinking, regression analysis showed that fat mass percentage (FMP) was negatively associated with abnormal BP, while LBM was positively associated with abnormal BP in boys(P < 0.05). Whereas FMP and visceral fat level (VFL) were positively associated with abnormal BP in girls (P < 0.05).

Conclusions

There are sex differences in the relationships between total body fat, visceral fat and lean body mass with abnormal BP in normal-weight youths. Therefore, it is of great significance to pay attention to the relative influence of the body composition of the boys and girls in the prevention and treatment of hypertension in youths.

Association of waist circumference with blood pressure and familial dietary habits in preschool children: a cross-sectional study in northeastern China

Background

Childhood obesity increases the risk of elevated blood pressure (BP) in children. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are traditional obesity indices, but the extent to which these indices are associated with elevated BP in childhood remains debatable. Moreover, the familial dietary environment plays an important role in obesity, so it is necessary to determine the most relevant dietary factors for childhood obesity to prevent elevated BP. Our study aimed to identify the obesity indices that are most closely associated with elevated BP and then to determine the independent familial dietary factors for those obesity indices.

Method

A total of 605 children aged 2 to 6 years, as well as their parents, were involved in this study. The weight, height, WC and BP of the children were measured. Information on familial environments was obtained by questionnaires completed by the parents. BMI, WC and WHtR were standardized into z scores, and categorical variables of these three obesity indices were defined as BMI Category, WC Category and WHtR Category. Logistic regression was used to analyse the associations between all obesity indices and elevated BP. Multivariate linear regression and logistic regression were used to determine the independent factors for obesity indices.

Results

The obesity indices that were most closely associated with elevated BP were WC and WC Category. Parental BMI, birth weight, eating wheat as a staple food, appetite, eating speed, snacking while watching TV, parental encouragement to eat a diverse assortment of foods and drinking milk were independently associated with WC in both males and females. The risk of abdominal obesity increased 1.375 times in males and 1.631 times in females if appetite increased one level. If eating speed increased one level, the risk of abdominal obesity increased 1.165 times in males and 0.905 times in females. Females who drank milk more than 6 times per week had a 0.546 times lower risk of abdominal obesity.

Conclusion

WC was an anthropometric parameter more closely associated with elevated BP. In addition to genetics, some familial dietary factors involving eating preference, eating habits and parental feeding practice were independently associated with WC and abdominal obesity in preschool children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13052-022-01236-3.

Diagnostic accuracy of anthropometric indices for discriminating elevated blood pressure in pediatric population: a systematic review and a meta-analysis

BACKGROUND

Childhood obesity is more likely to increase the chance of many adult health problems. Numerous studies have shown obese children to be more prone to elevated blood pressure (BP) and hypertension. It is important to identify an obesity anthropometric index with good discriminatory power for them in pediatric population.

METHODS

MEDLINE/PubMed, Web of Science, and Cochrane databases were retrieved comprehensively for eligible studies on childhood obesity and hypertension/elevated BP through June 2021. The systematic review and meta-analysis of studies used receiver operating characteristics (ROC) curves for evaluating the discriminatory power of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) in distinguishing children with elevated BP and hypertension.

RESULTS

21 cross-sectional studies involving 177,943 children and 3-19 years of age were included in our study. Meta-analysis showed that the pooled area under the reporting receiver-operating characteristic curves (AUC) and 95% confidence intervals (CIs) for BMI, WC, and WHtR to detect hypertension of boys were 0.68 (0.64, 0.72), 0.69 (0.64, 0.74), 0.67 (0.63, 0.71), for elevated BP, the pooled AUCs and 95% CIs were 0.67 (0.61, 0.73), 0.65 (0.58, 0.73), 0.65 (0.61, 0.71). The pooled AUCs and 95% CIs for BMI, WC and WHtR of predicting hypertension were 0.70 (0.66, 0.75), 0.69 (0.64, 0.75), 0.67 (0.63, 0.72) in girls, the pooled AUCs and 95% CIs of predicting elevated BP were 0.63 (0.61, 0.65), 0.62 (0.60, 0.65), 0.62 (0.60, 0.64) respectively. There was no anthropometric index was statistically superior in identifying hypertension and elevated BP, however, the accuracy of BMI predicting hypertension was significantly higher than elevated BP in girls (P < 0.05). The subgroup analysis for the comparison of BMI, WC and WHtR was performed, no significant difference in predicting hypertension and elevated BP in pediatric population.

CONCLUSIONS

This systematic review showed that no anthropometric index was superior in identifying hypertension and elevated BP in pediatric population. While compared with predicting elevated BP, all the indicators showed superiority in predicting hypertension in children, the difference was especially obvious in girls. A better anthropometric index should be explored to predict children's early blood pressure abnormalities.

Determinantes antropométricos da pressão arterial elevada em escolares do ensino fundamental

Introdução: A hipertensão arterial infantil vem recebendo atenção especial dos pediatras, pois o aumento da pressão arterial na infância contribui para o início precoce da hipertensão arterial essencial na idade adulta e para a mortalidade por doenças cardiovasculares. As medidas antropométricas têm sido úteis para o diagnóstico de sobrepeso e obesidade na infância, e tais condições são consideradas de risco para hipertensão arterial na idade adulta. Quanto mais precoce a identificação desses fatores de risco, seja no ambiente escolar, seja nos serviços de saúde, mais ações preventivas poderão ser desenvolvidas para minimizar tal problemática. Objetivo: Identificar a incidência de pressão arterial elevada e sua associação com medidas antropométricas em escolares do ensino fundamental. Métodos: Estudo longitudinal com 1.116 escolares; destes, 133 participaram de três avaliações no período de 2017 a 2019. As informações demográficas, as medidas antropométricas (peso, altura, circunferência abdominal, índice de massa corporal) e as pressóricas (sistólica e diastólica ajustadas de acordo com os parâmetros do Centro de Controle e Prevenção de Doenças para sexo e idade) foram registradas em formulário. A associação das variáveis com a pressão arterial elevada foi analisada por meio da regressão de Poisson, com ajuste robusto da variância. Resultados: Dos estudantes, 51,6% eram meninos com, em média, 7,9 anos, e 45,4% tinham pressão arterial elevada conforme os critérios do Centro de Controle e Prevenção de Doenças. Entre os que apresentaram circunferência abdominal elevada, 19,4% evoluíram de pressão sistólica normal para elevada e 35,5% de pressão diastólica normal para elevada ao longo dos três anos de acompanhamento. Nos escolares com sobrepeso ou obesidade, a pressão sistólica normal evoluiu para elevada em 20,7 e 21,2%, respectivamente, e a pressão diastólica normal evoluiu para elevada em 24,1 e 42,4%, respectivamente. Os escolares com circunferência abdominal (risco relativo – RR 1,51; intervalo de confiança – IC95% 1,20–1,91; RR 1,58; IC95% 1,25–2,00), peso (RR 1,37; IC95% 1,08–1,74; RR 1,34; IC95% 1,05–1,71) e índice de massa corporal elevado (RR 1,51; IC95% 1,21–1,87; RR 1,50; IC95% 1,20–1,88) apresentaram maior risco para hipertensão sistólica e diastólica, respectivamente. Conclusão: A circunferência abdominal, o peso e o índice de massa corporal estiveram associados com o aumento da pressão arterial sistólica e diastólica nos escolares, e o risco foi maior entre os que tinham circunferência abdominal aumentada.

Overweight and Obesity, Body Fat, Waist Circumference, and Anemia in Peruvian University Students: A Cross-Sectional Study

The university represents a critical space for students in terms of prevalence of malnutrition. The objective of this study was to determine the body mass index (BMI), body fat percentage (% BF), waist circumference (WC), and anemia in university students. A cross-sectional study was carried out in 2,285 university students from Lima, Peru. The sample was selected by nonprobability convenience sampling. Anthropometric data and hemoglobin levels were measured. The Chi-square test was used. The analysis of the associated factors was done using binary logistic regression. A significance level of 5% was considered. There were no significant differences between men and women in BMI (p > 0.05). The men presented significantly high and very high levels of % BF (p < 0.001). The proportion of women who presented anemia and high and very high WC was significantly higher compared to men (p < 0.001). Being older than 27 years (OR_B = 2.07; 95% CI = 1.19–3.6), being male (OR_B = 2.68; 95% CI = 2.02–3.55), studying at the engineering faculty (OR_B = 1.39; 95% CI = 1.09–1.79), having excess body fat (OR_B = 8.17; 95% CI = 6.13–10.87), and having an elevated WC (OR_B = 35.51; 95% CI = 25.06–50.33) significantly predicted overweight/obesity. The findings of this study suggest that college students, especially males and those who are not enrolled in health sciences colleges, should be a priority in healthy lifestyle interventions, particularly nutritional education programs, to reduce the prevalence of overweight and obesity.

Relative children's lipid accumulation with hypertension in Chinese children and adolescents

Background

This study aimed to develop a novel indicator associated with hypertension in Chinese children and adolescents, the relative children’s lipid accumulation product (RCLAP).

Methods

A cross-sectional study was conducted in 2018. A total of 683 students aged 8–15 years were recruited via a stratified cluster sampling Methods. Anthropometric indexes (waist circumference (WC), Body mass index (BMI), Waist-height ratio (WHtR), logarithm children LAP (LnCLAP), RCLAP per height (RCLAP-H)) were standardized using a z-score method (standardized variables: SWC, SBMI, SWHtR, SLnCLAP, SRCLAP-H). A logistic regression model was performed to evaluate the association of the above indicators with the outcome of hypertension.

Results

The overall prevalence of hypertension was 5.7% (5.5% in boys, 6.0% in girls). SWC ≥ P₇₅, SBMI ≥ P₇₅, SWHtR ≥ P₇₅, SlnCLAP ≥ P₇₅ and SRCLAP-H ≥ P₇₅ significantly increased risk of hypertension, with odds ratios (OR) of 2.21 (95% confidence interval (CI): 1.13, 4.30), 2.30 (1.18, 4.49), 2.64 (1.35, 5.14), 4.43 (2.28, 8.61), and 4.49 (2.31, 8.71), respectively.

Conclusion

RCLAP is a novel indicator associated with hypertension in Chinese children and adolescents, and it performs better than WC, BMI, WHtR and children LAP.

Association between anthropometric measures and insulin resistance in Brazilian adolescents: data from the national study of cardiovascular risk factors in adolescents - ERICA

OBJECTIVES

To evaluate anthropometric measures (AM) and insulin resistance (IR) association in adolescents aged 12-17 years and investigates how body mass index (BMI) interrelates with specific indicators of fat distribution in this association.

METHODS

This analysis is from the Study of Cardiovascular Risks in Adolescents (ERICA) study, a national, cross-sectional study. AM was categorized by quartiles, and their means and 95% confidence intervals (95% CI) were estimated. The prevalence of IR was estimated for each AM according to the quartiles. The associations between AM and homeostatic model assessment of insulin resistance (HOMA-IR) levels were analyzed using Poisson models.

RESULTS

37,892 adolescents were included. IR prevalence tended to increase as quartiles increased for each AM. The association of BMI with IR persisted with the adjustment for others AM. The greatest reduction in the association's strength was achieved with the adjustment by the waist circumference (WC) and the waist-to-height ratio (WHtR). Most other AM were also associated with IR.

CONCLUSION

AM has a positive association with the prevalence of IR, and the joint effect of BMI and central adiposity measures should be considered in cardiometabolic risk evaluation in adolescents.

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range.

The Olympic Experimental Gymnasium Program and its Association with the Prevalence of Cardiovascular Risk Factors in Adolescents: A Cross-Sectional Study

Background

Cardiovascular disease (CVD) is the leading cause of death worldwide. Physical activity (PA) and appropriate diet, if adopted in childhood and adolescence, may reduce the CVD burden in later life. The Olympic Experimental Gymnasium (OEG) project was implemented to increase the PA levels of students by means of regular physical exercise and healthy eating habits.

Objectives

To estimate and compare the prevalence of CVD risk factors in OEG schools versus regular schools (RSch) and to examine associations between the school environment and CVD risk factors.

Methods

In this cross-sectional study with a comparator group, adolescents aged 12-13 years attending three OEG schools (n = 719) and three RSch (n = 394) were evaluated after one year of the ongoing program to estimate the prevalence of overweight, pre-hypertension/hypertension, altered glycemia, and lipid profile. An α level of 0.05 was set for statistical analysis.

Results

RSch students had higher odds to have high blood pressure (OR 1.86, 1.36-2.54) and to be overweight (OR 1.49, 1.13-1.98) than OEG students. Glucose levels were not altered in most cases regardless of school type, and no differences were found in lipid profile. In the sensitivity analysis stratified by gender, girls from RSch were more likely to have high body mass index than boys.

Conclusions

Exposure of adolescents to the OEG policies was positively associated with an important reduction in CVD risk factors, including high blood pressure and overweight.