Pediatric Nephrology

, Volume 23, Issue 5, pp 787–796 | Cite as

Different BMI cardiovascular risk thresholds as markers of organ damage and metabolic syndrome in primary hypertension

  • Mieczysław Litwin
  • Joanna Śladowska
  • Małgorzata Syczewska
  • Anna Niemirska
  • Jadwiga Daszkowska
  • Jolanta Antoniewicz
  • Aldona Wierzbicka
  • Zbigniew T. Wawer
Original Article

Abstract

Obesity is the main intermediate phenotype of primary hypertension (PH), and increased fat mass is directly related to target organ damage (TOD) and metabolic syndrome (MS). The aim of the study was to assess the sensitivity and specificity of body mass index (BMI), percentile-based, definitions of obesity [BMI > 95th percentile (pc)], and overweight (BMI > 85th pc), and BMI thresholds for cardiovascular (cv) complications (BMIcv) described by Katzmarzyk et al. (Pediatrics 114:198–205, 2004) in predicting risk of TOD and MS in 122 adolescents with PH. Our results indicated that the prevalence of left ventricular hypertrophy (LVH) and carotid intima-media thickness (cIMT) above 2 standard deviations (SDS) was the same, irrespective of the criteria used. BMIcv was more sensitive as a marker of LVH than were the cut-off values of the 85th pc and 95th pc of BMI (87.5%, 75%, 62.5%, respectively; P < 0.0001). BMIcv thresholds and cut-off values of the 85th pc of BMI were of the same sensitivity in predicting the presence of MS (95.8% and 95.8%, respectively) and were more sensitive than the cut-off values of the BMI 95th pc (87.5%; P = 0.02). Metabolic abnormalities, including insulin resistance, were more marked in patients with greater BMI, irrespective of cut-off value. However, only when a stratification system using the 85th pc of BMI was used, were the differences significant for a homoeostasis model assessment for insulin resistance (HOMA-IR) and for serum concentrations of high-density lipoprotein (HDL)-cholesterol, triglycerides and adiponectin. We concluded that BMIcv is more sensitive for diagnosing the presence of LVH and that the cut-off value of the 85th pc of BMI is more sensitive for predicting presence of MS in children with PH.

Keywords

Primary hypertension Metabolic syndrome Left ventricular hypertrophy Children Cardiovascular risk Obesity 

References

  1. 1.
    Robinson RF, Batisky DL, Hayes JR, Nahata MC, Mahon JP (2004) Body mass index in primary and secondary hypertension. Pediatr Nephrol 19:1379–1384PubMedCrossRefGoogle Scholar
  2. 2.
    Flynn JT, Alderman MH (2005) Characteristics of children with primary hypertension seen at a referral center. Pediatr Nephrol 20:961–966PubMedCrossRefGoogle Scholar
  3. 3.
    Pludowski P, Litwin M, Sladowska J, Antoniewicz J, Niemirska A, Wierzbicka A, Lorenc RS (2008) Bone mass and body composition in children and adolescents with primary hypertension—preliminary data. Hypertension 51:77–83PubMedCrossRefGoogle Scholar
  4. 4.
    Kannel WB, Brand N, Skinner JJ Jr., Dawber TR, McNamara PM (1967) The relation of adiposity to blood pressure and development of hypertension. The Framingham study. Ann Intern Med 67:48–59PubMedGoogle Scholar
  5. 5.
    Sakarcan A, Jerrell J (2007) Population-based examination of the interaction of primary hypertension and obesity in South Carolina. Am J Hypertens 20:6–10PubMedCrossRefGoogle Scholar
  6. 6.
    Ogden CL, Flegal KM, Caroll MD, Johnson CL (2002) Prevalence and trends in overweight and obesity among US children and adolescent: 1999–2000. JAMA 288:1728–1732PubMedCrossRefGoogle Scholar
  7. 7.
    World Health Organisation (1998) Obesity: preventing the global epidemic. World Health Organisation, Geneva, SwitzerlandGoogle Scholar
  8. 8.
    Bellizzi MI, Dietz WH (1999) Workshop on childhood obesity: summary of the discussion. Am J Clin Nutr 70:173S–175SGoogle Scholar
  9. 9.
    Janssen I, Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS (2005) Utility of childhood BMI in the prediction of adulthood disease: comparison of national and international references. Obes Res 13:1106–1115PubMedGoogle Scholar
  10. 10.
    Katzmarzyk PT, Srinivasan SR, Chen W, Malina RM, Bouchard C, Berenson GS (2004) Body mass index, waist circumference and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 114:198–205CrossRefGoogle Scholar
  11. 11.
    Taylor B, Rochtchina E, Wang JJ, Wong TY, Heikel S, Saw SM, Mitchell P (2007) Body mass index and its effects on retinal vessel diameter in 6-year-old children. Int J Obes (Lond) 31:1527–1533CrossRefGoogle Scholar
  12. 12.
    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576Google Scholar
  13. 13.
    Litwin M, Niemirska A, Sladowska J, Antoniewicz J, Daszkowska J, Wierzbicka A, Wawer ZT, Grenda R (2006) Left ventricular hypertrophy and arterial wall thickening in children with essential hypertension. Pediatr Nephrol 21:811–819PubMedCrossRefGoogle Scholar
  14. 14.
    Jordan C, Wuehl E, Litwin M, Fahr K, Trelewicz J, Jobs K, Schenk JP, Grenda R, Mehls O, Troeger J, Schaefer F (2005) Normative values of intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 23:1707–1715CrossRefGoogle Scholar
  15. 15.
    de Simone G, Daniels SR, Deveraux RB, Meyer RA, Roman MJ, de Divitis O, Alderman MH (1992) Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol 20:1251–1260PubMedCrossRefGoogle Scholar
  16. 16.
    de Simone G, Deveraux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH (1995) Effect of growth on variability of left ventricular mass: assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 25:1056–1062PubMedCrossRefGoogle Scholar
  17. 17.
    Daniels SR (1999) Hypertension induced cardiac damage in children and adolescents. Blood Monit 4:165–170CrossRefGoogle Scholar
  18. 18.
    Gutt M, Davis CL, Spitzer SB, Llabre MM, Kumar M, Czarnecki EM, Schneiderman N, Skyler JS, Marks JB (2000) Validation of the insulin sensitivity index (ISI (0,120)): comparison with other measures. Diabetes Res Clin Pract 47:1777–1784CrossRefGoogle Scholar
  19. 19.
    Litwin M, Sladowska J, Antoniewicz J, Niemirska A, Wierzbicka A, Daszkowska J, Wawer ZT, Janas R, Grenda R (2007) Metabolic abnormalities, insulin resistance and metabolic syndrome in children with primary hypertension. Am J Hypertens 20:875–882PubMedCrossRefGoogle Scholar
  20. 20.
    Ford ES, Ajani VA, Mokhad IA, National Health and Nutrition Survey (2005) The metabolic syndrome and concentrations of C-reactive protein among US youth. Diabetes Care 28:878–881Google Scholar
  21. 21.
    Weiss RJ, Dziura J, Burgert TS, Tamberlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savaye M, Morrison J, Shervin RS, Caprio S (2004) Obesity and the metabolic syndrome in children and adolescents. N Engl J Med 350:2362–2374PubMedCrossRefGoogle Scholar
  22. 22.
    Luepker RV, Jacobs DR, Prineas RJ, Sinaiko AR (1999) Secular trends of blood pressure and body size in a multi-ethnic adolescent population: 1986 to 1996. J Pediatr 134:668–674PubMedCrossRefGoogle Scholar
  23. 23.
    Kulaga Z, Barwicka K (2007) Warsaw children become obese faster than American (abstract). Obes Rev 8 [Suppl 3]:17Google Scholar
  24. 24.
    Hanevold C, Waller J, Daniels S, Portman R, Sorof J (2004) The effects of obesity, gender and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113:328–333PubMedCrossRefGoogle Scholar
  25. 25.
    Tounian P, Aggoun Y, Dubern B, Varille V, Guy-Grand B, Sidi D, Girardet JP, Bonnet D (2001) Presence of increased stiffness of the common carotid artery and endothelial dysfunction in severely obese children: a prospective study. Lancet 358:1400–1404PubMedCrossRefGoogle Scholar
  26. 26.
    Lande MB, Carson NL, Roy J, Meagher CC (2006) Effects of childhood primary hypertension on carotid intima media thickness a matched controlled study. Hypertension 48:40–44PubMedCrossRefGoogle Scholar
  27. 27.
    Chi CH, Wang Y, Wilson DM, Robinson TN (2006) Definition of metabolic syndrome in preadolescent girls. J Pediatr 148:788–792PubMedCrossRefGoogle Scholar
  28. 28.
    Niemirska A, Litwin M, Antoniewicz J, Jurkiewicz E, Kosciesza I, Sladowska J, Janas R, Wawer ZT (2006) Fat tissue distribution and metabolic alterations in boys with primary hypertension. Przegl Lek 63 [Suppl 3]:49–53PubMedGoogle Scholar
  29. 29.
    Reinehr T, Andler W (2004) Changes in the atherogenic risk factor profile according to degree of weight loss. Arch Dis Child 89:419–422PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2008

Authors and Affiliations

  • Mieczysław Litwin
    • 1
    • 2
  • Joanna Śladowska
    • 2
  • Małgorzata Syczewska
    • 3
  • Anna Niemirska
    • 2
  • Jadwiga Daszkowska
    • 4
  • Jolanta Antoniewicz
    • 2
  • Aldona Wierzbicka
    • 5
  • Zbigniew T. Wawer
    • 5
  1. 1.Department of ResearchThe Children’s Memorial Health InstituteWarsawPoland
  2. 2.Department of Nephrology and Arterial HypertensionThe Children’s Memorial Health InstituteWarsawPoland
  3. 3.Department of RehabilitationThe Children’s Memorial Health InstituteWarsawPoland
  4. 4.Department of CardiologyThe Children’s Memorial Health InstituteWarsawPoland
  5. 5.Department of Laboratory DiagnosticsThe Children’s Memorial Health InstituteWarsawPoland

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