Skip to main content
SpringerLink
Log in

Pediatric body mass index trajectories and the risk of hypertension among adolescents in China: a retrospective cohort study

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

The impact of pediatric body mass index (BMI) trajectories on the risk of adolescent hypertension (HTN) determined by three separate visits remains unclear. This longitudinal study aims to identify potential pediatric sex-specific BMI trajectories and to assess their associations with HTN and HTN subtypes.

Methods

Based on the Health Promotion Program for Children and Adolescents (HPPCA) in Suzhou, China, a total of 24,426 participants who had initial normal blood pressure (BP) and had at least four BMI measurements during 2012–2020 were included. HTN was defined as simultaneously having three separate visits of elevated BP in 2020. Latent class growth models were used to explore sex-specific BMI trajectories, whose associations with HTN and HTN subtypes were further examined by logistic regression.

Results

The incidence of HTN determined through three separate visits was 3.34%. Four trajectories were identified for both sexes: low BMI increasing, medium BMI increasing, high BMI increasing, and highest BMI increasing. Compared to the medium BMI increasing group, the odds ratio (95% confidential interval) for developing adolescent HTN of the low, high, and highest BMI increasing groups among boys were 0.54 (0.39, 0.75), 1.90 (1.44, 2.51), and 2.89 (1.90, 4.39), respectively; and the corresponding values for girls were 0.66 (0.48, 0.90), 2.30 (1.72, 3.09), and 4.71 (3.06, 7.26). Similar gradually elevated associations between different trajectories with isolated systolic hypertension, systolic and diastolic hypertension were observed.

Conclusion

Current results emphasized the adverse effects of stable high BMI on HTN and the benefits of maintaining normal weight throughout childhood.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data are only available on an approved request to the corresponding author.

References

  1. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease, and mortality in 155722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet. 2020;395:795–808.

    Article  Google Scholar 

  2. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–88.

    Article  Google Scholar 

  3. Redwine KM, Acosta AA, Poffenbarger T, Portman RJ, Samuels J. Development of hypertension in adolescents with pre-hypertension. J Pediatr. 2012;160:98–103.

    Article  Google Scholar 

  4. Liang YJ, Xi B, Hu YH, Wang C, Liu JT, Yan YK, et al. Trends in blood pressure and hypertension among Chinese children and adolescents: China Health and Nutrition Surveys 1991–2004. Blood Press. 2011;20:45–53.

    Article  Google Scholar 

  5. Liu K, Li C, Gong H, Guo Y, Hou B, Chen L, et al. Prevalence and risk factors for hypertension in adolescents aged 12 to 17 years: a school-based study in China. Hypertension. 2021;78:1577–85.

    Article  CAS  Google Scholar 

  6. Dong J, Dong H, Yan Y, Cheng H, Zhao X, Mi J, et al. Prevalence of hypertension and hypertension phenotypes after three visits in Chinese urban children. J Hypertens. 2022;40:1270–7.

    CAS  Google Scholar 

  7. Kollias A, Dafni M, Poulidakis E, Ntineri A, Stergiou GS. Out-of-office blood pressure and target organ damage in children and adolescents: a systematic review and meta-analysis. J Hypertens. 2014;32:2315–31.

    Article  CAS  Google Scholar 

  8. Yang L, Sun J, Zhao M, Liang Y, Bovet P, Xi B. Elevated blood pressure in childhood and hypertension risk in adulthood: a systematic review and meta-analysis. J Hypertens. 2020;38:2346–55.

    Article  CAS  Google Scholar 

  9. Franks PW, Hanson RL, Knowler WC, Sievers ML, Bennett PH, Looker HC. Childhood obesity, other cardiovascular risk factors, and premature death. N Engl J Med. 2010;362:485–93.

    Article  CAS  Google Scholar 

  10. Wang C, Yuan Y, Zheng M, Pan A, Wang M, Zhao M, et al. Association of age of onset of hypertension with cardiovascular diseases and mortality. J Am Coll Cardiol. 2020;75:2921–30.

    Article  Google Scholar 

  11. Gorostidi M, Vinyoles E, Banegas JR, de la Sierra A. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens Res. 2015;38:1–7.

    Article  Google Scholar 

  12. Kollias A, Ntineri A, Stergiou GS. Is white-coat hypertension a harbinger of increased risk? Hypertens Res. 2014;37:791–5.

    Article  Google Scholar 

  13. Zhang Q, Yang L, Zhang Y, Zhao M, Liang Y, Xi B. Hypertension prevalence based on three separate visits and its association with obesity among Chinese children and adolescents. Front Pediatr. 2019;7:307.

    Article  CAS  Google Scholar 

  14. Sun J, Steffen LM, Ma C, Liang Y, Xi B. Definition of pediatric hypertension: are blood pressure measurements on three separate occasions necessary? Hypertens Res. 2017;40:496–503.

    Article  Google Scholar 

  15. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904.

    Article  Google Scholar 

  16. National Health Commission of the People’s Republic of China. Reference of screening for elevated blood pressure among children and adolescents aged 7–18 years (WS/T 610–2018). Beijing: Standards Press of China; 2018.

    Google Scholar 

  17. Teng H, Hu J, Ge W, Dai Q, Liu J, Xiao C, et al. Body mass index trajectories during 6–18 years old and the risk of hypertension in young adult: a longitudinal study in Chinese population. Int J Hypertens. 2021;2021:6646868.

    Article  Google Scholar 

  18. Wang X, Dong B, Huang S, Ma Y, Zou Z, Ma J, et al. Body mass index trajectory and incident hypertension: results from a longitudinal cohort of Chinese children and adolescents, 2006–2016. Am J Public Health. 2020;110:1689–95.

    Article  Google Scholar 

  19. Fan H, Zhang X. Body mass index trajectory across childhood and subsequent risk of elevated blood pressure. J Clin Hypertens (Greenwich). 2020;22:1902–7.

    Article  Google Scholar 

  20. Parker ED, Sinaiko AR, Kharbanda EO, Margolis KL, Daley MF, Trower NK, et al. Change in weight status and development of hypertension. Pediatrics. 2016;137:e20151662.

    Article  Google Scholar 

  21. Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, Force USPST, et al. Screening for obesity in children and adolescents: US preventive services task force recommendation statement. JAMA. 2017;317:2417–26.

    Article  Google Scholar 

  22. Rosner B, Cook NR, Daniels S, Falkner B. Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988–2008. Hypertension. 2013;62:247–54.

    Article  CAS  Google Scholar 

  23. Mattsson M, Maher GM, Boland F, Fitzgerald AP, Murray DM, Biesma R. Group-based trajectory modelling for BMI trajectories in childhood: a systematic review. Obes Rev. 2019;20:998–1015.

    Article  Google Scholar 

  24. Rolland-Cachera MF, Deheeger M, Maillot M, Bellisle F. Early adiposity rebound: causes and consequences for obesity in children and adults. Int J Obes (Lond). 2006;30:S11–7.

    Article  Google Scholar 

  25. Meigen C, Keller A, Gausche R, Kromeyer-Hauschild K, Bluher S, Kiess W, et al. Secular trends in body mass index in German children and adolescents: a cross-sectional data analysis via CrescNet between 1999 and 2006. Metabolism. 2008;57:934–9.

    Article  CAS  Google Scholar 

  26. Hu J, Chu GP, Huang FF, Zhou YK, Teng CG, Yang HB, et al. Relation of body mass index (BMI) to the prevalence of hypertension in children: a 3 years’ school-based prospective study in Suzhou. China Int J Cardiol. 2016;222:270–4.

    Article  Google Scholar 

  27. Hu J, Liu JY, Wang JX, Shen MZ, Ge WX, Shen H, et al. Unfavorable progression of obesity in children and adolescents due to COVID-19 pandemic: a school-based survey in China. Obesity. 2021;29:1907–15.

    Article  CAS  Google Scholar 

  28. Ge W, Hu J, Xiao Y, Liang F, Yi L, Zhu R, et al. COVID-19 related childhood BMI increases in China: a health surveillance based ambispective cohort analysis. Am J Prev Med. 2022;000:1–9.

    Google Scholar 

  29. National Health Commission of the People’s Republic of China. Screening standard for malnutrition of school-age children and adolescents (WS/T 456–2014). Beijing: Standards Press of China; 2014.

    Google Scholar 

  30. National Health Commission of the People’s Republic of China. Screening for overweight and obesity among school-age children and adolescents (WS/T 586–2018). Beijing: Standards Press of China; 2018.

    Google Scholar 

  31. Jones BL, Nagin D, Roeder K. A SAS procedure based on mixture models for estimating developmental trajectories. Soc Method Res. 2001;29:374–93.

    Article  Google Scholar 

  32. Andruff H, Carraro N, Thompson A, Gaudreau P. Latent class growth modeling a tutorial. Quant Meth Psych. 2009;5:11–24.

    Google Scholar 

  33. Wang J, Zhu Y, Jing J, Chen Y, Mai J, Wong SH, et al. Relationship of BMI to the incidence of hypertension: a 4 years’ cohort study among children in Guangzhou, 2007–2011. BMC Public Health. 2015;15:782.

    Article  Google Scholar 

  34. Montazeri P, Fossati S, Clemente DBP, Cirugeda L, Elosua R, Fernandez-Barres S, et al. Early-childhood BMI trajectories in relation to preclinical cardiovascular measurements in adolescence. J Dev Orig Health Dis. 2022;13:322–9.

    Article  Google Scholar 

  35. Ahanchi NS, Ramezankhani A, Munthali RJ, Asgari S, Azizi F, Hadaegh F. Body mass index trajectories from adolescent to young adult for incident high blood pressure and high plasma glucose. PLoS ONE. 2019;14:e0213828.

    Article  Google Scholar 

  36. Munthali RJ, Kagura J, Lombard Z, Norris SA. Childhood adiposity trajectories are associated with late adolescent blood pressure: birth to twenty cohort. BMC Public Health. 2016;16:665.

    Article  Google Scholar 

  37. Oluwagbemigun K, Buyken AE, Alexy U, Schmid M, Herder C, Nothlings U. Developmental trajectories of body mass index from childhood into late adolescence and subsequent late adolescence-young adulthood cardiometabolic risk markers. Cardiovasc Diabetol. 2019;18:9.

    Article  Google Scholar 

  38. Cheung EL, Bell CS, Samuel JP, Poffenbarger T, Redwine KM, Samuels JA. Race and obesity in adolescent hypertension. Pediatrics. 2017;139:e20161433.

    Article  Google Scholar 

  39. Wildman RP, Mackey RH, Bostom A, Thompson T, Sutton-Tyrrell K. Measures of obesity are associated with vascular stiffness in young and older adults. Hypertension. 2003;42:468–73.

    Article  CAS  Google Scholar 

  40. Palatini P, Rosei EA, Avolio A, Bilo G, Casiglia E, Ghiadoni L, et al. Isolated systolic hypertension in the young: a position paper endorsed by the European Society of Hypertension. J Hypertens. 2018;36:1222–36.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We sincerely appreciate all the children, parents, and workers who were involved in the study.

Funding

This work was supported by Gusu Health Talents Program Training Project in Suzhou, China (GSWS2020100), the National Natural Science Foundation of China (81602911, 82204070, and 82273635), and Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD).

Author information

Authors and Affiliations

  1. Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, China

    Wen-Xin Ge, Zhuo-Qiao Yang, Xin-Nan Wang, Yue Xiao, Fei Liang & Jie-Yun Yin

  2. Suzhou Center for Disease Prevention and Control, 72 Sanxiang Road, Suzhou, 215004, China

    Di Han, Zi-Yao Ding, Bo Hai, Hui Shen, Hai-Bing Yang & Jia Hu

  3. Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China

    Zi-Yao Ding

  4. Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, China

    Li-Ping Yi

  5. State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing, China

    Hui-Ling Lv, Hui Shen, Hai-Bing Yang & Jia Hu

  6. Suzhou Institute of Advanced Study in Public Health, Gusu School, Nanjing Medical University, Suzhou, China

    Hui Shen, Hai-Bing Yang & Jia Hu

Authors
  1. Wen-Xin Ge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Di Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zi-Yao Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Li-Ping Yi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhuo-Qiao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xin-Nan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yue Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fei Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bo Hai
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hui-Ling Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hui Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hai-Bing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jie-Yun Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jia Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GWX: writing–original draft. HD, DZY, HB, LHL, SH, and YHB: data curation, formal analyses. YLP, YZQ, WXN, XY, and LF: writing–review and editing. YJY, HJ: conceptualization. GWX and HD contributed equally to this study. All authors had final approval of the submitted and published versions.

Corresponding authors

Correspondence to Jie-Yun Yin or Jia Hu.

Ethics declarations

Conflict of interest

No financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

Ethical approval

All work was carried out with the consent of participants and their parents. This study was approved by the Ethics Committee of Suzhou Center for Disease Prevention and Control (No.SZJK2020-XW001).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 134 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ge, WX., Han, D., Ding, ZY. et al. Pediatric body mass index trajectories and the risk of hypertension among adolescents in China: a retrospective cohort study. World J Pediatr 19, 76–86 (2023). https://doi.org/10.1007/s12519-022-00626-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-022-00626-1

Keywords

Search

Navigation