Body Adiposity is Associated With a Risk of High Blood Pressure in Macedonian Children

Volume 11, Issue 2 (2021)

Body Adiposity is Associated With a Risk of High Blood Pressure in Macedonian Children
Zorica Stankovska, Biljana Bojadzieva Stojanoska, Seryozha Gontarev, Žarko Kostovski
Abstract: 
The goal of this study was to determine the relationship between waist circumference (WC), body mass index (BMI), body fat percentage (BFP), waist-to-height ratio (WHtR), adiposity index (API) and high blood pressure (HBP) and to determine which anthropometric parameters can best predict HBP in Macedonian children from 6 to 10 years of age. The research was conducted on a sample of 1228 boys and girls from 6 to 10 years of age. Blood pressure was measured three times in an interval of 60 seconds, and the mean value of the three measurements was used as a result for processing. Logistic regression analysis was used to assess the associations and to calculate odds ratios. Adjusted odds ratios in the highest quartiles of WC, BMI, BFP and WHtR were statistically significant in boys (girls): hypertension – 5.19 (6.38), 3.16 (3.76), 4.39 (4.48), and 3.95 (4.84). In Macedonian children from 6 to 10 years of age, the anthropometric indices - WC and API (particularly WC) - showed stronger associations with HBP and were better at predicting HBP, compared to the other applied anthropometric indices.
Keywords: 
Blood pressure, Schoolchildren, Adiposity, Weight status.
Full Text: 
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References: 
Ashwell, M., & Hsieh, S. D. (2005). Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. International journal of food sciences and nutrition, 56(5), 303-307.
Barreira, T. V., Broyles, S. T., Gupta, A. K., & Katzmarzyk, P. T. (2014). Relationship of anthropometric indices to abdominal and total body fat in youth: sex and race differences. Obesity, 22(5), 1345-1350.
Berker, D., Koparal, S., Isik, S., Pasaoglu, L., Aydin, Y., Erol, K., ... & Guler, S. (2010). Compatibility of different methods for the measurement of visceral fat in different body mass index strata. Diagn Interv Radiol, 16(2), 99-105
Brambilla, P., Bedogni, G., Moreno, L. A., Goran, M. I., Gutin, B., Fox, K. R., ... & Pietrobelli, A. (2006). Crossvalidation of anthropometry against magnetic resonance imaging for the assessment of visceral and subcutaneous adipose tissue in children. International journal of obesity, 30(1), 23-30.
Cairella, G., Menghetti, E., Scanu, A., Bevilacqua, N., Censi, L., Martone, D., ... & D’Addesa, D. (2007). Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity. Annali di igiene: medicina preventiva e di comunita, 19(3), 203-214.
Chen, T. L., Choy, C. S., Chan, W. Y., Chen, C. H., & Liao, C. C. (2012). Waist-to-height ratio and elevated blood pressure among children in Taiwan. Indian pediatrics, 49(6), 463-466.
Choy, C. S., Chan, W. Y., Chen, T. L., Shih, C. C., Wu, L. C., & Liao, C. C. (2011). Waist circumference and risk of elevated blood pressure in children: a cross-sectional study. BMC Public Health, 11(1), 613.
Christofaro, D. G., Fernandes, R. A., Gerage, A. M., Alves, M. J., Polito, M. D., & Oliveira, A. R. (2009). Validation of the Omron HEM 742 blood pressure monitoring device in adolescents. Arq Bras Cardiol, 92(1), 10-5.
De Moraes, A. C. F., Carvalho, H. B., Siani, A., Barba, G., Veidebaum, T., Tornaritis, M., ... & Mårild, S. (2015). Incidence of high blood pressure in children—Effects of physical activity and sedentary behaviors: The IDEFICS study: High blood pressure, lifestyle and children. International journal of cardiology, 180, 165-170.
Dorresteijn, J. A. N., Visseren, F. L. J., & Spiering, W. (2012). Mechanisms linking obesity to hypertension. Obesity Reviews, 13(1), 17-26.
Ebbeling, C. B., Pawlak, D. B., & Ludwig, D. S. (2002). Childhood obesity: public-health crisis, common sense cure. The lancet, 360(9331), 473-482.
Ewald, D. R., & Haldeman, L. A. (2016). Risk factors in adolescent hypertension. Global Pediatric Health, 3, 2333794X15625159.
Falkner, B. (2010). Hypertension in children and adolescents: epidemiology and natural history. Pediatric nephrology, 25(7), 1219-1224.
Forkert, E. C., Rendo-Urteaga, T., Nascimento-Ferreira, M. V., de Moraes, A. C. F., Moreno, L. A., & de Carvalho, H. B. (2016). Abdominal obesity and cardiometabolic risk in children and adolescents, are we aware of their relevance?. Nutrire, 41(1), 15.
Güngör, N. K. (2014). Overweight and obesity in children and adolescents. Journal of clinical research in pediatric endocrinology, 6(3), 129
Guo, X., Zhang, X., Guo, L., Li, Z., Zheng, L., Yu, S., ... & Li, J. (2013). Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Current Hypertension Reports, 15(6), 703-716.
Guo, X., Zhang, X., Li, Y., Zhou, X., Yang, H., Ma, H., ... & Sun, Y. (2012). Differences in healthy lifestyles between prehypertensive and normotensive children and adolescents in Northern China. Pediatric cardiology, 33(2), 222-228.
Hansen, M. L., Gunn, P. W., & Kaelber, D. C. (2007). Underdiagnosis of hypertension in children and adolescents. Jama, 298(8), 874-879.
Karatzi, K., Protogerou, A. D., Moschonis, G., Tsirimiagou, C., Androutsos, O., Chrousos, G. P., ... & Manios, Y. (2017). Prevalence of hypertension and hypertension phenotypes by age and gender among schoolchildren in Greece: The Healthy Growth Study. Atherosclerosis, 259, 128-133.
Kromeyer-Hauschild, K., Neuhauser, H., Rosario, A. S., & Schienkiewitz, A. (2013). Abdominal obesity in German adolescents defined by waist-to-height ratio and its association to elevated blood pressure: the KiGGS study. Obesity facts, 6(2), 165-175.
Ledoux, T., Watson, K., Baranowski, J., Tepper, B. J., & Baranowski, T. (2011). Overeating styles and adiposity among multiethnic youth. Appetite, 56(1), 71-77.
Liang, Y., & Jie, M. I. (2011). Pubertal hypertension is a strong predictor for the risk of adult hypertension. Biomedical and Environmental Sciences, 24(5), 459-466.
Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., ... & Aryee, M. (2012). A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet, 380(9859), 2224-2260.
Litwin, M. (2018). Why should we screen for arterial hypertension in children and adolescents?. Pediatric Nephrology, 33(1), 83-92.
Lu, Y., Luo, B., Xie, J., Zhang, X., & Zhu, H. (2018). Prevalence of hypertension and prehypertension and its association with anthropometrics among children: a cross-sectional survey in Tianjin, China. Journal of Human Hypertension, 32(11), 789-798.
Maldonado, J., Pereira, T., Fernandes, R., Santos, R., & Carvalho, M. (2011). An approach of hypertension prevalence in a sample of 5381
Portuguese children and adolescents. The AVELEIRA registry.“Hypertension in Children”. Blood pressure, 20(3), 153-157.
Martin-Calvo, N., Moreno-Galarraga, L., & Martinez-Gonzalez, M. A. (2016). Association between body mass index, waist-to-height ratio and adiposity in children: a systematic review and meta-analysis. Nutrients, 8(8), 512.
Martin-Espinosa, N., Díez-Fernández, A., Sánchez-López, M., Rivero-Merino, I., Lucas-De La Cruz, L., Solera-Martinez, M., ... & Movi-Kids group. (2017). Prevalence of high blood pressure and association with obesity in Spanish schoolchildren aged 4–6 years old. PLoS One, 12(1), e0170926.
Millar, S. R., Perry, I. J., & Phillips, C. M. (2013). Surrogate measures of adiposity and cardiometabolic risk-why the uncertainty? a review of recent meta-analytic studies. Journal Of Diabetes & Metabolism, 4.
Mishra, P. E., Shastri, L., Thomas, T., Duggan, C., Bosch, R., McDonald, C. M., ... & Kuriyan, R. (2015). Waist-to-height ratio as an indicator of high blood pressure in urban Indian school children. Indian pediatrics, 52(9), 773-778.
Moschonis, G., Karatzi, K., Androutsos, O., Lionis, C., Chrousos, G. P., & Manios, Y. (2018). Anthropometric cut-off values identifying Greek children at risk of hypertension: the Healthy Growth Study. Journal of human hypertension, 32(3), 190-196.
National High Blood Pressure Education Program. (2005). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents (No. 5). US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, National Hight Blood Pressure Education Program.
Nkeh-Chungag, B. N., Sekokotla, A. M., Sewani-Rusike, C., Namugowa, A., & Iputo, J. E. (2015). Prevalence of hypertension and pre-hypertension in 13-17 year old adolescents living in Mthatha-South Africa: A cross-sectional study. Central European Journal of Public Health, 23(1), 59-64.
Rosner, B., Cook, N. R., Daniels, S., & Falkner, B. (2013). Childhood blood pressure trends and risk factors for high blood pressure: the NHANES experience 1988–2008. Hypertension, 62(2), 247-254.
Schneider, H. J., Klotsche, J., Silber, S., Stalla, G. K., & Wittchen, H. U. (2011). Measuring abdominal obesity: effects of height on distribution of cardiometabolic risk factors risk using waist circumference and waist-to-height ratio. Diabetes care, 34(1), e7-e7.
Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Predicting adult obesity from childhood obesity: a systematic review and meta‐analysis. Obesity reviews, 17(2), 95-107.
Sommer, A., & Twig, G. (2018). The impact of childhood and adolescent obesity on cardiovascular risk in adulthood: a systematic review. Current diabetes reports, 18(10), 91.
Toschke, A. M., Kohl, L., Mansmann, U., & Von Kries, R. (2010). Meta‐analysis of blood pressure tracking from childhood to adulthood and implications for the design of intervention trials. Acta paediatrica, 99(1), 24-29.
Tybor, D. J., Lichtenstein, A. H., Dallal, G. E., & Must, A. (2008). Waist-to-height ratio is correlated with height in US children and adolescents aged 2–18 years. International Journal of Pediatric Obesity, 3(3), 148-151.
Urbina, E. M., Khoury, P. R., McCoy, C., Daniels, S. R., Kimball, T. R., & Dolan, L. M. (2011). Cardiac and vascular consequences of pre‐hypertension in youth. The Journal of Clinical Hypertension, 13(5), 332-342.
World Health Organization. (2009). Global health risks: mortality and burden of disease attributable to selected major risks. World Health Organization.
World Health Organization. (2013). A global brief on hypertension: silent killer, global public health crisis: World Health Day 2013 (No. WHO/DCO/WHD/2013.2). World Health Organization.
Yang, C., & Wang, L. (2017). Comparisons of waist circumference measurements at five different anatomical sites in Chinese children. BioMed research international, 2017.
Yoo, E. G. (2016). Waist-to-height ratio as a screening tool for obesity and cardiometabolic risk. Korean journal of pediatrics, 59(11), 425.
Zhang, Y. X., Zhao, J. S., & Chu, Z. H. (2016). Children and adolescents with low body mass index but large waist circumference remain high risk of elevated blood pressure. International Journal of Cardiology, 215, 23-25.