Abstract
Background: Hypertension in children is becoming a growing heath problem, with increasing prevalence. Objectives: To examine the relationship of body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), waist stature ratio (WSR) and conicity index (CI) with blood pressure and to differentiate the screening potential of BMI, WC, WHR, WSR and CI for the presence of hypertension in children. Method: A school-based cross-sectional study was carried out in 2017 on 13-16 year old Bengali children in two schools (a boys’ school and a girl’s school) from Howrah city, West Bengal where stature (ST), weight (WT), WC and hip circumference (HC) were measured, and BMI, WHR, WSR and CI calculated. Schools were randomly selected from the list of affiliated schools under the West Bengal Board of Secondary Education. All 13-16 year old children from the two schools were recruited after obtaining informed consent from parents and assent from the children. Children with pre-existing serious illnesses and deformities were excluded from the study. Bio-social information was obtained using an open-ended schedule. Age was obtained from the school register. Hypertension was defined as age and stature adjusted systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95th percentile. Partial correlations, logistic regressions and area under the receiver operating characteristic curves (AUC) were estimated to understand the relationship of adiposity measure with blood pressure and hypertension. Results: A total of 535 adolescents, comprising 282 boys and 253 girls aged 13–16 years, participated in this study. There was no statistically significant sex difference in age. Overall prevalence of hypertension was 8.5%. All adiposity measures were positively correlated with blood pressures. Logistic regression showed that BMI had the strongest associations with hypertension in both sexes. The AUC for BMI (0.82, 95% CI 0.751 to 0.895) was higher than those of other adiposity measures in assessing hypertension in boys. However, in girls, both BMI (AUC 0.75, 95% CI 0.644 to 0.856) and WSR (AUC 0.75, 95% CI 0.638 to 0.865) had similar higher assessment ability for hypertension compares to other measures. Conclusions: BMI had the highest odds ratio for hypertension, and was the best adiposity measure to assess hypertension.
Highlights
Today, in developing countries, there is a marked shift from communicable to non-communicable diseases[1]
All adiposity measures were positively correlated with blood pressures
The AUC for body mass index (BMI) (0.82, 95% Conicity index (CI) 0.751 to 0.895) was higher than those of other adiposity measures in assessing hypertension in boys
Summary
In developing countries, there is a marked shift from communicable to non-communicable diseases[1]. Studies show a high prevalence of obesity among children globally[2]. Obesity is the most significant risk factor for childhood hypertension[3,4]. Obese children have a threefold greater risk for high blood pressure compared to non-obese children[5]. Hypertension is identified as the third major risk factor of deaths among children, and the prevalence of hypertension in children is increasing[6]. High blood pressure in children is associated with increased cardiac morbidity and mortality[10]. Rather than the extent of obesity, determines the hypertension risk[11]. There is little data on the relationship between body fat distribution and the risk of high blood pressure in Indian children. Hypertension in children is becoming a growing heath problem, with increasing prevalence
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