Are Rural Indian Children and Adolescents Ages 9–18 years at Risk of Hypertension? A Multicenter Study

Abstract

Abstract Objectives Among urban (U) and rural (R) Indian children ages 9–18 years, we aimed to (1) assess prevalence and determinants of primary hypertension (PH) (2) evaluate differences in fat indices (BMI, waist circumference, tricep skinfold thickness), body composition (BC, fat and muscle mass (MM)), weight-adjusted resting metabolic rate (RMR/Wt), diet, and physical activity (PA). Methods Date from 2016–2017 Multicentre Study, representative of children (9–18 yrs) from 5 states, were analysed (n = 1818, urban 895, rural = 923). All anthropometric parameters (Z-scores were calculated), BP, BC, RMR were measured. Two day 24 hrs diet recall was collected, nutrient and food group intakes were calculated; PA was assessed. Children and adolescents were categorised as normo or pre + hypertensive (>90th percentile) and Students t-tests, chi-sq tests, and ANOVA used for comparison, regression analysis was carried out for determinants. Results U children and adolescents were significantly taller, heavier, overweight + obese (25 vs 11%), pre + hypertensive (18 vs 10%), adipose and had lower RMR/Wt. All children with PH had higher fat indices, and lower MM and RMR/Wt than normotensives (P < 0.05). Rural PH children had more junk food, simple carbohydrate(CHO), fat and sodium than normotensives while nutrient intakes were similar in normo and PH urban children. U children were more inactive than the R children (U 606 ± 434 vs R 574 ± 403 minutes/week). In U children, fat intake contributed more to total calories consumed (U-30 vs R-25%), R children had higher contribution of calories from CHO (U-59 vs R-65%). BMI (R2 46 vs 34%), WC(R2 33 vs 22%), TSFT(R2 21 vs 16%) and sodium (R2 1% both) were found to be positive predictors, while RMR/Wt (R2 28% vs 33%), Ca, Mg, (R2 2% both) and vigorus PA (R2 2% vs 1%) were negative predictors for BP in U, R children (P < 0.05). Conclusions Our study highlights that R children are also at risk of developing PH especially those with higher intake of junk food and CHO. Another interesting finding of our study was the negative association of PH with RMR/Wt; Increasing PA along with a micronutrient rich diet with Ca and Mg is vital to prevent PH. Health care policies need to focus on the increasing prevalence of obesity and PH in not only U, but also R children where different strategies may have to be applied. Funding Sources University Grant Commission, Government of India.