Skip to main content
SpringerLink
Log in

Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents

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

A Publisher Correction to this article was published on 13 January 2024

This article has been updated

Abstract

Background

The age of onset of hypertension (HTN) is decreasing, and obesity is a significant risk factor. The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied. This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN.

Methods

Seven thousand, five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8–18 years from the 2013–2015 China Child and Adolescent Cardiovascular Health study and the 2011–2018 National Health and Nutrition Examination Surveys were analyzed. Blood pressure and body composition (fat and muscle) were measured by trained staff. The crude prevalence and age-standardized prevalence rate (ASPR) of primary HTN and its subtypes [isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH)] were calculated based on 2017 American Academy of Pediatrics guidelines. Multivariable-adjusted linear regression coefficients and odds ratios (ORs) were calculated to assess the associations of body composition indicators with HTN, ISH and IDH.

Results

The ASPR of HTN was 18.5% in China (CN) and 4.6% in the United States (US), whereas the obesity prevalence was 7.4% and 18.6%, and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN. Increased fat mass, muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries. The percent of muscle body mass had a protective effect on HTN and ISH in both countries [HTN (CN: OR = 0.83, 95% CI = 0.78–0.88; US: OR = 0.72, 95% CI = 0.64–0.81); ISH (CN: OR = 0.87, 95% CI = 0.80–0.94; US: OR = 0.71, 95% CI = 0.62–0.81)], and the protective effect was more common among children and adolescents with high levels of physical activity.

Conclusions

The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US, and the contribution of obesity to HTN was higher in the US than in CN. Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations. Optimizing body composition positively influences blood pressure in children and adolescents, particularly those with high-level physical activity.

Video abstract (MP4 149982 KB)

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

Similar content being viewed by others

Data availability

The datasets about CCACH generated and analyzed during the current study are available from the corresponding author on reasonable request. The datasets about NHANES generated and analyzed during the present study are available in the NHANES repository, https://www.cdc.gov/nchs/nhanes/index.htm (accessed on October 20, 2022).

Change history

References

  1. Chen X, Wang Y. Tracking of blood pressure from childhood to adulthood: a systematic review and meta-regression analysis. Circulation. 2008;117:3171–80.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Drozdz D, Alvarez-Pitti J, Wójcik M, Borghi C, Gabbianelli R, Mazur A, et al. Obesity and cardiometabolic risk factors: from childhood to adulthood. Nutrients. 2021;13:4176.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    Article  PubMed  Google Scholar 

  4. Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18:785–802.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hardy ST, Sakhuja S, Jaeger BC, Urbina EM, Suglia SF, Feig DI, et al. Trends in blood pressure and hypertension among US children and adolescents, 1999–2018. JAMA Netw Open. 2021;4:e213917.

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wu LW, Lin YY, Kao TW, Lin CM, Wang CC, Wang GC, et al. Mid-arm circumference and all-cause, cardiovascular, and cancer mortality among obese and non-obese us adults: the national health and nutrition examination survey III. Sci Rep. 2017;7:2302.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kotsis V, Jordan J, Micic D, Finer N, Leitner DR, Toplak H, et al. Obesity and cardiovascular risk: a call for action from the European society of hypertension working group of obesity, diabetes and the high-risk patient and European association for the study of obesity: part a: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment. J Hypertens. 2018;36:1427–40.

    Article  CAS  PubMed  Google Scholar 

  9. Jacobs DR Jr, Woo JG, Sinaiko AR, Daniels SR, Ikonen J, Juonala M, et al. Childhood cardiovascular risk factors and adult cardiovascular events. N Engl J Med. 2022;386:1877–88.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Freedman DS, Goodman A, Contreras OA, DasMahapatra P, Srinivasan SR, Berenson GS. Secular trends in BMI and blood pressure among children and adolescents: the Bogalusa heart study. Pediatrics. 2012;130:e159–66.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shirasawa T, Ochiai H, Nishimura R, Morimoto A, Shimada N, Ohtsu T, et al. Secular trends in blood pressure among Japanese schoolchildren: a population-based annual survey from 1994 to 2010. J Epidemiol. 2012;22:448–53.

    Article  PubMed  Google Scholar 

  12. Peters H, Whincup PH, Cook DG, Law C, Li L. Trends in blood pressure in 9 to 11-year-old children in the United Kingdom 1980–2008: the impact of obesity. J Hypertens. 2012;30:1708–17.

    Article  CAS  PubMed  Google Scholar 

  13. Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation. 2007;116:1488–96.

    Article  PubMed  Google Scholar 

  14. Garn SM, Leonard WR, Hawthorne VM. Three limitations of the body mass index. Am J Clin Nutr. 1986;44:996–7.

    Article  CAS  PubMed  Google Scholar 

  15. Javed A, Jumean M, Murad MH, Okorodudu D, Kumar S, Somers VK, et al. Diagnostic performance of body mass index to identify obesity as defined by body adiposity in children and adolescents: a systematic review and meta-analysis. Pediatr Obes. 2015;10:234–44.

    Article  CAS  PubMed  Google Scholar 

  16. Qi Q, Sun K, Rong Y, Li Z, Wu Y, Zhang D, et al. Body composition of the upper limb associated with hypertension, hypercholesterolemia, and diabetes. Front Endocrinol (Lausanne). 2022;13:985031.

    Article  PubMed  Google Scholar 

  17. Ye S, Zhu C, Wei C, Yang M, Zheng W, Gan D, et al. Associations of body composition with blood pressure and hypertension. Obesity (Silver Spring). 2018;26:1644–50.

    Article  PubMed  Google Scholar 

  18. Vaziri Y, Bulduk S, Shadman Z, Bulduk EO, Hedayati M, Koc H, et al. Lean body mass as a predictive value of hypertension in young adults, in Ankara. Turkey Iran J Public Health. 2015;44:1643–54.

    PubMed  Google Scholar 

  19. Palaniappan LP, Carnethon MR, Fortmann SP. Heterogeneity in the relationship between ethnicity, BMI, and fasting insulin. Diabetes Care. 2002;25:1351–7.

    Article  PubMed  Google Scholar 

  20. Carnethon MR, Palaniappan LP, Burchfiel CM, Brancati FL, Fortmann SP. Serum insulin, obesity, and the incidence of type 2 diabetes in black and white adults: the atherosclerosis risk in communities study: 1987–1998. Diabetes Care. 2002;25:1358–64.

    Article  PubMed  Google Scholar 

  21. Caleyachetty R, Barber TM, Mohammed NI, Cappuccio FP, Hardy R, Mathur R, et al. Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: a population-based cohort study. Lancet Diabetes Endocrinol. 2021;9:419–26.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tramunt B, Smati S, Grandgeorge N, Lenfant F, Arnal JF, Montagner A, et al. Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia. 2020;63:453–61.

    Article  PubMed  Google Scholar 

  23. Cooper AJ, Gupta SR, Moustafa AF, Chao AM. Sex/gender differences in obesity prevalence, comorbidities, and treatment. Curr Obes Rep. 2021;10:458–66.

    Article  PubMed  Google Scholar 

  24. Bosello O, Vanzo A. Obesity paradox and aging. Eat Weight Disord. 2021;26:27–35.

    Article  PubMed  Google Scholar 

  25. Muller MJ, Lagerpusch M, Enderle J, Schautz B, Heller M, Bosy-Westphal A. Beyond the body mass index: tracking body composition in the pathogenesis of obesity and the metabolic syndrome. Obes Rev. 2012;2:6–13.

    Article  Google Scholar 

  26. Liu JT, Yan YY, Xi B, Huang GM, Mi J, China Child and Adolescent Cardiovascular Health (CCACH) Study Group. Skeletal muscle reference for Chinese children and adolescents. J Cachexia Sarcopenia Muscle. 2019;10:155–64.

    Article  PubMed  Google Scholar 

  27. The 2018 Physical Activity Guidelines Advisory Committee. 2018 physical activity guidelines advisory committee scientific report. Washington DC: US Department of Health and Human Services; 2018.

  28. Centers for Disease Control and Prevention/National Center for Health Statistics. The National Health and Nutrition Examination Survey. https://www.cdc.gov/nchs/nhanes/index.htm. Accessed 20 Oct 2022.

  29. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. 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;40:e20171904.

    Article  Google Scholar 

  31. Greenland S, Drescher K. Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics. 1993;49:865–72.

    Article  CAS  PubMed  Google Scholar 

  32. Newson R. PUNAF: Stata module to compute population attributable fractions for case-control and survival studies. Statistical Software Components S457354 from Boston College Department of Economics. 2023.

  33. Cao ZQ, Zhu L, Zhang T, Wu L, Wang Y. Blood pressure and obesity among adolescents: a school-based population study in China. Am J Hypertens. 2012;25:576–82.

    Article  PubMed  Google Scholar 

  34. 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  PubMed  Google Scholar 

  35. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al. Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American heart association. Hypertension. 2014;63:1116–35.

    Article  CAS  PubMed  Google Scholar 

  36. Chiolero A, Cachat F, Burnier M, Paccaud F, Bovet P. Prevalence of hypertension in school children based on repeated measurements and association with overweight. J Hypertens. 2007;25:2209–17.

    Article  CAS  PubMed  Google Scholar 

  37. Lurbe E, Torro MI, Alvarez-Pitti J, Redon P, Redon J. Central blood pressure and pulse wave amplification across the spectrum of peripheral blood pressure in overweight and obese youth. J Hypertens. 2016;34:1389–95.

    Article  CAS  PubMed  Google Scholar 

  38. Karatzi K, Protogerou AD, Moschonis G, Tsirimiagou C, Androutsos O, Chrousos GP, et al. Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: the healthy growth study. Atherosclerosis. 2017;259:128–33.

    Article  CAS  PubMed  Google Scholar 

  39. Staessen J, Amery A, Fagard R. Isolated systolic hypertension in the elderly. J Hypertens. 1990;8:393–405.

    Article  CAS  PubMed  Google Scholar 

  40. Dong Y, Ma J, Song Y, Ma Y, Dong B, Zou Z, et al. Secular trends in blood pressure and overweight and obesity in Chinese boys and girls aged 7 to 17 years from 1995 to 2014. Hypertension. 2018;72:298–305.

    Article  CAS  PubMed  Google Scholar 

  41. Fan J, Shi X, Jia X, Wang Y, Zhao Y, Bao J, et al. Birth weight, childhood obesity and risk of hypertension: a Mendelian randomization study. J Hypertens. 2021;39:1876–83.

    Article  CAS  PubMed  Google Scholar 

  42. Li W, Fang W, Huang Z, Wang X, Cai Z, Chen G, et al. Association between age at onset of overweight and risk of hypertension across adulthood. Heart. 2022;108:683–8.

    Article  PubMed  Google Scholar 

  43. Brouillard AM, Deych E, Canter C, Rich MW. Trends in sodium intake in children and adolescents in the US and the impact of US department of agriculture guidelines: NHANES 2003–2016. J Pediatr. 2020;225:117–23.

    Article  CAS  PubMed  Google Scholar 

  44. Du S, Batis C, Wang H, Zhang B, Zhang J, Popkin BM. Understanding the patterns and trends of sodium intake, potassium intake, and sodium to potassium ratio and their effect on hypertension in China. Am J Clin Nutr. 2014;99:334–43.

    Article  CAS  PubMed  Google Scholar 

  45. Deng WW, Wang J, Liu MM, Wang D, Zhao Y, Liu YQ, et al. Body mass index compared with abdominal obesity indicators in relation to prehypertension and hypertension in adults: the CHPSNE study. Am J Hypertens. 2013;26:58–67.

    Article  PubMed  Google Scholar 

  46. Doll S, Paccaud F, Bovet P, Burnier M, Wietlisbach V. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes Relat Metab Disord. 2002;26:48–57.

    Article  CAS  PubMed  Google Scholar 

  47. Bai L, Zhou J, Tong L, Ding W. Association between body composition and blood pressure in normal-weight Chinese children and adolescents. BMC Pediatr. 2022;22:240.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Gao L, Cheng H, Yan Y, Liu J, Shan X, Wang X, et al. The associations of muscle mass with glucose and lipid metabolism are influenced by body fat accumulation in children and adolescents. Front Endocrinol (Lausanne). 2022;13:976998.

    Article  PubMed  Google Scholar 

  49. Han JM, Lee MY, Lee KB, Kim H, Hyun YY. Low relative skeletal muscle mass predicts incident hypertension in Korean men: a prospective cohort study. J Hypertens. 2020;38:2223–9.

    Article  CAS  PubMed  Google Scholar 

  50. DeFronzo RA, Jacot E, Jequier E, Maeder E, Wahren J, Felber JP. The effect of insulin on the disposal of intravenous glucose. Results from indirect calorimetry and hepatic and femoral venous catheterization. Diabetes. 1981;30:1000–7.

    Article  CAS  PubMed  Google Scholar 

  51. Ferrannini E, Bjorkman O, Reichard GA Jr, Pilo A, Olsson M, Wahren J, et al. The disposal of an oral glucose load in healthy subjects. Quant Study Diabetes. 1985;34:580–8.

    CAS  Google Scholar 

  52. Wu H, Ballantyne CM. Skeletal muscle inflammation and insulin resistance in obesity. J Clin Invest. 2017;127:43–54.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Im IJ, Choi HJ, Jeong SM, Kim HJ, Son JS, Oh HJ. The association between muscle mass deficits and arterial stiffness in middle-aged men. Nutr Metab Cardiovasc Dis. 2017;27:1130–5.

    Article  CAS  PubMed  Google Scholar 

  54. Severinsen MCK, Pedersen BK. Muscle-organ crosstalk: the emerging roles of myokines. Endocr Rev. 2020;41:594–609.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Raitakari O, Pahkala K, Magnussen CG. Prevention of atherosclerosis from childhood. Nat Rev Cardiol. 2022;19:543–54.

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by the National Natural Science Foundation of China (grant numbers: 81973110 and 82204062).

Author information

Authors and Affiliations

  1. Center for Non-Communicable Disease Management, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China

    Li-Wang Gao, Yi-Wen Huang, Xi Wang, Hong-Bo Dong, Pei Xiao, Yin-Kun Yan & Jie Mi

  2. Department of Epidemiology, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China

    Hong Cheng, Xin-Ying Shan, Xiao-Yuan Zhao & Jie Mi

  3. Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China

    Jie Mi

Authors
  1. Li-Wang Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi-Wen Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hong Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong-Bo Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pei Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yin-Kun Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Xin-Ying Shan
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Xiao-Yuan Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jie Mi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GLW, HYW and CH contributed equally to this study. GLW contributed to conceptualization, data curation, formal analysis, funding acquisition, methodology, project administration, and writing of the original draft. HYW contributed to data curation, formal analysis, and methodology. CH contributed to project administration. WX contributed to data curation. DHB and XP contributed to supervision. MJ contributed to conceptualization, funding acquisition, methodology, project administration, and supervision. All the authors contributed to the discussion and reviewed the manuscript and had final approval of the submitted and published versions.

Corresponding author

Correspondence to Jie Mi.

Ethics declarations

Ethical approval

The China Child and Adolescent Cardiovascular Health (CCACH) study received ethical approval from the Ethics Committee of the Capital Institute of Pediatrics (approval number: 2012062), and the US National Health and Nutrition Examination Surveys (NHANES) data collection was approved by the US Centers for Disease Control and Prevention/National Center for Health Statistics Ethics Review Board. Informed consents to participate in the study have been obtained from participants (or their parent or legal guardian in the case of children and adolescents under 18).

Conflict of interest

No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflict of interest to declare.

Additional information

Publisher's Note

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

The original online version of this article was revised: During production process, the video abstract has been inadvertently missed to include in the online version.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file 1 (PDF 147 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) 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

Gao, LW., Huang, YW., Cheng, H. et al. Prevalence of hypertension and its associations with body composition across Chinese and American children and adolescents. World J Pediatr 20, 392–403 (2024). https://doi.org/10.1007/s12519-023-00740-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-023-00740-8

Keywords

Search

Navigation