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Comparison of blood pressure levels among children and adolescents with different body mass index and waist circumference: study in a large sample in Shandong, China

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Abstract

Purpose

Several anthropometric indicators [such as body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)] have been used to investigate the association between adiposity and high blood pressure (BP) in both adults and children. The present study compared the BP levels among children and adolescents with different BMI and WC in a large population in Shandong, China.

Methods

A total of 38,822 students (19,456 boys and 19,366 girls) aged 7–17 years participated in this study. Height, weight, WC, and BP of all subjects were measured, and BMI was calculated. The prevalence of overweight and obesity was obtained according to the International Obesity Task Force (IOTF) cutoffs; central obesity was defined as WC ≥ 90th percentile (P 90); relatively high BP status was defined as systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥ 95th percentile for age and gender.

Results

Within each BMI categories (normal weight, overweight, and obesity), children and adolescents with WC ≥ P 90 had higher BP levels than those with WC < P 90 (p < 0.01). When BMI and WC were combined, the highest and lowest prevalences of relatively high BP were noted in obese with WC ≥ P 90 group (54.52 % for boys and 48.71 % for girls) and normal weight with WC < P 90 group (17.00 % for boys and 14.13 % for girls).

Conclusion

Children and adolescents with high BMI and high WC might have an increased risk of elevated BP. Our results suggest that the additional measurement of WC is better than BMI alone to help identify high BP risks.

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References

  1. Rosner B, Prineas RJ, Loggie JMH, Daniels SR (1993) Blood pressure nomograms for children and adolescents, by height, sex and age, in the United States. J Pediatr 123:871–886

    Article  CAS  Google Scholar 

  2. Lurbe E, Redon J (2000) Ambulatory blood pressure monitoring in children and adolescents: the future. J Hypertens 18:1351–1354

    Article  CAS  Google Scholar 

  3. Bao W, Threefoot SA, Srinivasan SR, Berenson GS (1995) Essential hypertension predicted by tracking of elevated blood pressure from childhood to adulthood: the bogalusa heart study. Am J Hypertens 8:657–665

    Article  CAS  Google Scholar 

  4. Cook NR, Gillman MW, Rosner BA, Taylor JO, Hennekens CH (1997) Prediction of young adult blood pressure from childhood blood pressure, height, and weight. J Clin Epidemiol 50:571–579

    Article  CAS  Google Scholar 

  5. Vos LE, Oren A, Bots ML, Gorissen WH, Grobbee DE, Uiterwaal CS (2003) Does a routinely measured blood pressure in young adolescence accurately predict hypertension and total cardiovascular risk in young adulthood? J Hypertens 21:2027–2034

    Article  CAS  Google Scholar 

  6. Sun SS, Grave GD, Siervogel RM, Pickoff AA, Arslanian SS, Daniels SR (2007) Systolic blood pressure in childhood predicts hypertension and metabolic syndrome later in life. Pediatrics 119:237–246

    Article  Google Scholar 

  7. Chen X, Wang Y (2008) Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation 117:3171–3180

    Article  Google Scholar 

  8. Nguyen M, Mitsnefes M (2007) Evaluation of hypertension by the general pediatrician. Curr Opin Pediatr 19:165–169

    Article  Google Scholar 

  9. Feber J, Ahmed M (2010) Hypertension in children: new trends and challenges. Clin Sci 119:151–161

    Article  Google Scholar 

  10. Liang YJ, Xi B, Hu YH, Wang C, Liu JT, Yan YK, Xu T, Wang RQ (2011) Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991–2004. Blood Press 20:45–53

    Article  Google Scholar 

  11. Zhang YX, Zhao JS, Sun GZ, Lin M, Chu ZH (2012) Prevalent trends in relatively high blood pressure among children and adolescents in Shandong, China. Ann Hum Biol 39:259–263

    Article  Google Scholar 

  12. Daniels SR, Pratt CA, Hayman LL (2011) Reduction of risk for cardiovascular disease in children and adolescents. Circulation 124:1673–1686

    Article  Google Scholar 

  13. Barton M (2010) Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Pediatrics 125:361–367

    Article  Google Scholar 

  14. Makgae PJ, Monyeki KD, Brits SJ, Kemper HCG, Mashita J (2007) Somatotype and blood pressure of rural South African children aged 6–13 years: Ellisras longitudinal growth and health study. Ann Hum Biol 34:240–251

    Article  CAS  Google Scholar 

  15. Ataei N, Hosseini M, Iranmanesh M (2009) The relationship of body mass index and blood pressure in Iranian children, 7 years old. J Trop Pediatr 55:313–317

    Article  Google Scholar 

  16. Zhang YX, Wang SR (2011) The relationship of body mass index distribution to relatively high blood pressure among children and adolescents in Shandong, China. Ann Hum Biol 38:630–634

    Article  Google Scholar 

  17. Despres JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444:881–887

    Article  CAS  Google Scholar 

  18. Ji CY, Sung RYT, Ma GS, Ma J, He ZH, Chen TJ (2010) Waist circumference distribution of Chinese school-age children and adolescents. Biomed Environ Sci 23:12–20

    Article  Google Scholar 

  19. Research Section of the Constitution and Health of Chinese Students (RSCHCS) (2007) Report on the physical fitness and health surveillance of Chinese school students. Higher Education Press, Beijing, pp 161–177 [in Chinese]

  20. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international study. BMJ 320:1240–1243

    Article  CAS  Google Scholar 

  21. Mi J, Wang TY, Meng LH, Zhu GJ, Han SM, Zhong Y, Liu GM, Wan YP, Xiong F, Shi JP, Yan WL, Zhou PM (2010) Development of blood pressure reference standards for Chinese children and adolescents. Chin J Evid Based Pediatr 15:4–14 [in Chinese]

    Google Scholar 

  22. Savva SC, Tornaritis M, Savva ME, Kourides Y, Panagi A, Silikiotou N, Georgiou C, Kafatos A (2000) Waist circumference and waist-to-height ratio are better predictors of cardiovascular disease risk factors in children than body mass index. Int J Obes Relat Metab Disord 24:1453–1458

    Article  CAS  Google Scholar 

  23. Janssen I, Katzmarzyk PT, Ross R (2004) Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 79:379–384

    CAS  Google Scholar 

  24. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK (2004) Trends in blood pressure among children and adolescents. JAMA 91:2107–2113

    Article  Google Scholar 

  25. Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. New Engl J Med 350:2362–2374

    Article  CAS  Google Scholar 

  26. Lee JM, Davis MM, Woolford SJ, Gurney JG (2009) Waist circumference percentile thresholds for identifying adolescents with insulin resistance in clinical practice. Pediatr Diabetes 10:336–342

    Article  Google Scholar 

  27. Poh BK, Jannah AN, Chong LK, Ruzita AT, Ismail MN, Mccarthy D (2011) Waist circumference percentile curves for Malaysian children and adolescents aged 6.0–16.9 years. Int J Pediatr Obes 6:229–235

    Article  Google Scholar 

  28. Maffeis C, Pietrobelli A, Grezzani A, Provera S, Tato L (2001) Waist circumference and cardiovascular risk factors in prepubertal children. Obes Res 9:179–187

    Article  CAS  Google Scholar 

  29. McCarthy HD, Ashwell M (2006) A study of central fatness using waist-to-height ratios in UK children and adolescents over two decades supports the simple message: ‘keep your waist circumference to less than half your height’. Int J Obes (Lond) 30:988–992

    Article  CAS  Google Scholar 

  30. Garnett SP, Baur LA, Cowell CT (2008) Waist-to-height ratio: a simple option for determining excess central adiposity in young people. Int J Obes (Lond) 32:1028–1030

    Article  CAS  Google Scholar 

  31. Huxley R, Mendis S, Zheleznyakov E, Reddy S, Chan J (2010) Body mass index, waist circumference and waist:hip ratio as predictors of cardiovascular risk: a review of the literature. Eur J Clin Nutr 64:16–22

    Article  CAS  Google Scholar 

  32. Lee S, Bacha F, Arslanian SA (2006) Waist circumference, blood pressure, and lipid components of the metabolic syndrome. J Pediatr 149:809–816

    Article  CAS  Google Scholar 

  33. Kovacs VA, Gabor A, Fajcsak Z, Martos E (2010) Role of waist circumference in predicting the risk of high blood pressure in children. Int J Pediatr Obes 5:143–150

    Article  Google Scholar 

  34. Khoury M, Manlhiot C, Dobbin S, Gibson D, Chahal N, Wong H, Davies J, Stearne K, Fisher A, McCrindle BW (2012) Role of waist measures in characterizing the lipid and blood pressure assessment of adolescents classified by body mass index. Arch Pediatr Adolesc Med 166:719–724

    Article  Google Scholar 

  35. Ebbeling CB, Pawlak DB, Ludwig DS (2002) Childhood obesity: public health crisis, common sense cure. Lancet 360:473–482

    Article  Google Scholar 

  36. Lobstein T, Baur L, Uauy R (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5(Suppl 1):4–85

    Article  Google Scholar 

  37. Freedman DS, Dietz WH, Srinivasan SR, Berenson GS (1999) The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103:1175–1182

    Article  CAS  Google Scholar 

  38. Sorof J, Daniels S (2002) Obesity hypertension in children. A problem of epidemic proportions. Hypertension 40:441–447

    Article  CAS  Google Scholar 

  39. Croix B, Feig DI (2006) Childhood hypertension is not a silent disease. Pediatr Nephrol 21:527–532

    Article  Google Scholar 

  40. Ji CY, Cheng TO (2008) Prevalence and geographic distribution of childhood obesity in China in 2005. Int J Cardiol 131:1–8

    Article  Google Scholar 

  41. Zhou JY, Zhang JL (2008). Dietary nutrition and health status of Shandong population. Jinan, Shandong, China: Shandong electronic audio & video publishing house p. 17 [in Chinese]

  42. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

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Acknowledgments

This study was supported by the medical and health program of Shandong, China (2009-HZ049). Surveys on students’ constitution and health are conducted under the auspices of the department of education in Shandong Province, China. We thank all the team members and all participants. Special thanks to Mr. B Yu for providing access to the survey data.

Conflicts of interest

There are no conflicts of interest on behalf of any of the authors.

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Authors and Affiliations

  1. Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014, Shandong, China

    Ying-Xiu Zhang

  2. Shandong Blood Center, 22 Shanshidong Road, Jinan, 250014, Shandong, China

    Shu-Rong Wang

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  1. Ying-Xiu Zhang
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  2. Shu-Rong Wang
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Correspondence to Ying-Xiu Zhang.

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Zhang, YX., Wang, SR. Comparison of blood pressure levels among children and adolescents with different body mass index and waist circumference: study in a large sample in Shandong, China . Eur J Nutr 53, 627–634 (2014). https://doi.org/10.1007/s00394-013-0571-1

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  • DOI: https://doi.org/10.1007/s00394-013-0571-1

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