Blood Pressure Percentiles Research Articles

Fluid balance assessment in pediatric hemodialysis patients by using whole-body bioimpedance spectroscopy (WB-BIS).

Fluid overload is a major factor in morbidity and mortality in dialysis patients. Whole-body bioimpedance spectroscopy (WB-BIS) is a noninvasive method for assessing fluid status. We hypothesized that fluid status measurement of changes in total body water (TBW), extracellular fluid (ECF), and intracellular fluid (ICF) by WB-BIS would correlate with the weight (Wt) changes before and after hemodialysis (HD) and the amount of ultrafiltration (UF) in pediatric HD patients. We also examined the relationship between the ECF percent of total body water (ECF%) and ECF/ICF ratio with the pre-HD systolic blood pressure percentile (SBP%ile). WB-BIS measurements were made both before and after HD on three separate occasions in each patient. Pre- and post-HD Wt, BP, and UF volumes were collected on the day of BIS measurement. At total of 96 measurements were obtained from 16 HD patients. There were 6 females (mean age: 13.2 ± 4.5 yrs). UF correlated with changes in weight, TBW and ECF (p < 0.001) but not with ICF changes (p = 0.345). Pre-HD SBP%ile correlated with ECF%. Our findings suggest that WB-BIS can be used to monitor the fluid status in pediatric HD patients. The fluid that is removed from the patient during the HD treatment primarily comes from the ECF and not the ICF. Mobilization of fluid from the ICF appears to be delayed. Patients with significantly higher pre-HD ECF% and ECF/ICF ratio had higher pre-HD systolic BP. A higher resolution version of the Graphical abstract is available as Supplementary information.

Development of Hypertension Diagnostic Cutoff Values in 6–15 Years Old Children in Haikou City and Their Comparison With the National Standard

Abstract Background To develop the diagnostic criteria of childhood hypertension for different sex, age, and height in Haikou City and compare them with the national standard. Methods Stratified random cluster sampling method was used to sample 11,497 students from 227 classes of 29 primary and secondary schools at Haikou. Their height, weight, and blood pressure (BP) were measured during October 2013 to December 2014. The BP values were obtained with method of Korotkoff mercury sphygmomanometer by the trained examiners. Non-Haikou students and abnormal discrete samples were excluded. A total of 9,100 students of normal weight and height, aged 6–15 years, were enrolled. The sex-, age-, and height-specific BP percentile of 90%, 95%, and 99% (P90, P95, and P99) were calculated. Results The sex-, age-, and height-specific BP cutoff values of prehypertension (P90), grade 1 hypertension (P95), and grade 2 hypertension (P99) of children aged 6–15 years were developed. Compared with the 2017 national reference (“reference 2017”), the following characteristics were observed. The average height and height range of the same percentile in children at Haikou were lower. The P90 and P95 of systolic BP in Haikou were similar in most age groups of both sexes, but 4–5 mm Hg lower in 15-year-old males. Likewise, the P99 of systolic BP in Haikou was 1–8 mm Hg higher, except for 15-year-old males, which was 2 mm Hg lower. The difference of P90, P95, and P99 of diastolic BP between Haikou and “reference 2017” ranged from −1 to 5 mm Hg. Conclusions Hypertension of children aged 6–15 years in Haikou has its own characteristics and is different from the “reference 2017.”

DNMT3A and TET2; Potential Estimates of Generic DNA Methylation in Children and Adolescents with Obesity; Relation to Metabolic Dysregulation

Introduction: The role of DNA methylation in metabolic dysregulation is emerging. However, the functional role of methylation in obesity and metabolic dysregulation is poorly understood. Aim: The aim of this study was to compare DNA methyltransferase-3A (DNMT3A) and ten-eleven translocase-2 (TET2) levels in children and adolescents with obesity to normal-weighed children and adolescents and to correlate them to various metabolic parameters. Methods: Fifty children and adolescents with obesity were compared to 50 matched normal-weighed children and adolescents. Participants underwent assessment for anthropometric measurements, Tanner staging, acanthosis nigricans, and mean blood pressure percentile on three different occasions. TET2, DNMT3A, fasting lipids, and insulin were measured with calculation of the homeostatic model assessment insulin resistance (HOMA-IR). Results: The median BMI SDS of the studied children and adolescents with obesity was 3.40, their mean TET2 was 178.40 ng/mL, and their mean DNMT3A was 2.18 ng/mL. TET2 is significantly lower (p = 0.009), while DNMT3A is significantly higher (p < 0.001) in children and adolescents with obesity than controls. Children and adolescents with obesity and insulin resistance have significantly lower TET2 (p = 0.012) and significantly higher DNMT3A (p = 0.013) than those without insulin resistance. Diastolic blood pressure percentile and HOMA-IR are positively correlated to DNMT3A (p < 0.001) and negatively correlated to TET-2 (p < 0.001). Multivariate logistic regression analysis revealed that TET2 and DNMT3A are independently associated with diastolic blood pressure percentile (p = 0.03 and p = 0.014, respectively) and HOMA-IR (p = 0.003 and p = 0.001, respectively). Conclusions: Children and adolescents with obesity have significantly higher DNMT3A and significantly lower TET2 than controls. This is more evident in those having insulin resistance than those without. DNMT3A and TET2 are independently associated with systemic hypertension and insulin resistance in children with obesity.

Effects of blood pressure percentile, body mass index, and race on left ventricular mass in children.

To evaluate the association of systolic blood pressure percentile, race, and body mass index with left ventricular hypertrophy on electrocardiogram and echocardiogram to define populations at risk. This is a retrospective cross-sectional study design utilising a data analytics tool (Tableau) combining electrocardiogram and echocardiogram databases from 2003 to 2020. Customized queries identified patients aged 2-18 years who had an outpatient electrocardiogram and echocardiogram on the same date with available systolic blood pressure and body measurements. Cases with CHD, cardiomyopathy, or arrhythmia diagnoses were excluded. Echocardiograms with left ventricle mass (indexed to height2.7) were included. The main outcome was left ventricular hypertrophy on echocardiogram defined as Left ventricle mass index greater than the 95th percentile for age. In a cohort of 13,539 patients, 6.7% of studies had left ventricular hypertrophy on echocardiogram. Systolic blood pressure percentile >90% has a sensitivity of 35% and specificity of 82% for left ventricular hypertrophy on echocardiogram. Left ventricular hypertrophy on electrocardiogram was a poor predictor of left ventricular hypertrophy on echocardiogram (9% sensitivity and 92% specificity). African American race (OR 1.31, 95% CI = 1.10, 1.56, p = 0.002), systolic blood pressure percentile >95% (OR = 1.60, 95% CI = 1.34, 1.93, p < 0.001), and higher body mass index (OR = 7.22, 95% CI = 6.23, 8.36, p < 0.001) were independently associated with left ventricular hypertrophy on echocardiogram. African American race, obesity, and hypertension on outpatient blood pressure measurements are independent risk factors for left ventricular hypertrophy in children. Electrocardiogram has little utility in the screening for left ventricular hypertrophy.

Cardiovascular risk and cardiovascular risk factors in adolescents.

to identify cardiovascular risk and cardiovascular risk factors in adolescents and verify correlations between these variables and biochemical markers, and between blood pressure percentiles, Body Mass Index, and biochemical markers. a cross-sectional study, conducted at a Brazilian school, from August to September 2019, including 205 participants who were interviewed. After the interview, anthropometric assessments, including weight, height, arm circumference, blood pressure checking, and blood collection for laboratory tests were performed. Descriptive and inferential analysis using the chi-square test was conducted. a total of 18.5% had blood pressure percentiles >95%, 25.4% were overweight, and 25.9% were at very high cardiovascular risk. Statistically significant associations were found between cardiovascular risk and sex, Body Mass Index and blood pressure percentiles, and between blood pressure percentiles and triglycerides. high prevalence of risk factors among school adolescents reinforces the need for interventions for cardiovascular risk reduction in this population.

Integrase Strand Transfer Inhibitors &amp; Weight Gain in Children with Perinatal HIV

Background: In the past, HIV infection was associated with weight loss due to metabolic wasting. Now with early initiation of antiretroviral therapy (ART) an increasing number of patients are being classified as overweight/ obese both prior to initiation and during the course of ART. Certain integrase strand transfer inhibitors (INSTIs) have been associated with weight gain in the adult population, but data in the pediatric population is lacking. This study explores the association of ART with an INSTI backbone and changes in weight and body mass index (BMI) in children with perinatal HIV who are followed in the HIV clinic at Riley Hospital.&#x0D; Methods: We performed a retrospective review of 59 patients with perinatally acquired HIV from 2016 to 2021. Weight, BMI, z-score, blood pressure (BP) percentiles, and lipid panels were recorded from the patients’ most recent visit. BMI and BP percentiles were compared between patients on Bictegravir, Dolutegravir, and Elvitegravir. For patients currently on an INSTI-backbone ART regimen, BMI was compared before and up to 5 years after INSTI initiation.&#x0D; Results: In our cross-sectional analysis between patients on Bictegravir, Dolutegravir, and Elvitegravir there was no significant difference in BMI (p=0.859), systolic BP percentile (p=0.188), or diastolic BP percentile (p=0.541). In our longitudinal analysis, we observed a significant increase in BMI over 3 years compared to pre-INSTI initiation (p=0.049). In addition, we observed an upwards trend with patients on Bictegravir (p=0.094) and Elvitegravir (p=0.121).&#x0D; Conclusion/Impact: Our study suggests that ART regimens with an INSTI backbone are associated with greater increases in BMIs. Our study is limited by a small n, but provides pilot data to direct future studies. It also illustrates that emphasis on healthy body weight maintenance may be necessary when patients are placed on ART regimens with INSTI backbones.

Association between gestational blood pressure and pregnancy induced hypertension or pre-eclampsia

Objective: To construct the gestational-age-specific blood pressure curve and percentile blood pressure values of pregnant women in Jiangsu Province, and to explore the clinic significance of the blood pressure changes in women whose blood pressure was less than 140/90 mmHg (1 mmHg=0.133 kPa) in each trimester and eventually developed pregnancy induced hypertension (PIH) or pre-eclampsia (PE). Methods: A prospective longitudinal cohort during pregnancy was built. Singleton pregnant women in the first trimester (11-13+6 weeks) were recruited from July 2017 to September 2020 in Nanjing Drum Tower Hospital, and were followed up in the second trimester (19-23+6 weeks), the third trimester (30-33+6 weeks) and approaching the expected date of delivery (35-38+6 weeks). The Viewpoint 6.0 software was used to record pregnancy-related information. The blood pressure was measured by standard methods in our clinic. Least mean square (LMS) function was performed to fit the gestational-age-specific blood pressure curve and percentile blood pressure values were calculated at every follow-up time point. Logistic regression was applied to calculate the OR for the groups with blood pressure ≥95th percentile (P95). Results: There were 3 728 singleton pregnant women invited in this study, including 3 490 normal pregnant women (93.62%, 3 490/3 728), and 238 pregnant women with PIH or PE (6.38%, 238/3 728). Gestational-age-specific blood pressure curve showed that systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) decreased in the second trimester, compared with those in the first and the third trimester, however the fluctuation of blood pressure was low, but regardless of the gestational age, P95 of SBP, DBP and MAP increased by 14, 11 and 11 mmHg respectively, compared with 50th percentile (P50). In the first trimester, the risk of developing PIH or PE finally in pregnant women with blood pressure ≥P95 was 4.36-fold (95%CI: 2.99-6.35) for SBP than women with SBP<P95, 5.22-fold (95%CI: 3.65-7.46) for DBP and 5.14-fold (95%CI: 3.61-7.32) for MAP. When approaching the expected date of delivery, the corresponding risks of the women with blood pressure ≥P95 were 16.76 times, 27.45 and 27.31 times respectively than those of the women with blood pressure <P95. In the first trimester, every 1 mmHg elevation of SBP the risk developing PIH or PE increased by 24% (OR=1.24, 95%CI: 1.15-1.33), 44% (OR=1.44, 95%CI: 1.31-1.59) for DBP and 47% (OR=1.47, 95%CI: 1.33-1.61) for MAP, respectively. The risk in the second trimester was similar to that in the first trimester, and in the third trimester, the risk was further increased. When approaching the expected date of delivery, DBP or MAP increased by 1 mmHg, the risk developing PIH or PE was double; while SBP increased by 1 mmHg, the risk increased by 58%. The areas under the receiver operator characteristic curves of SBP, DBP and MAP were similar for predicting PIH or PE, and the predictive efficiency were all poor. Conclusions: Construction of percentile blood pressure values for pregnant women is helpful in identification of high-risk women of developing PIH or PE. The risk of PIH or PE in pregnant women with blood pressure ≥P95 but <140/90 mmHg has significantly increased compared with women with blood pressure <P95.

Comparison of China Reference with Different National and International References: The Prevalence of High Blood Pressure in 695,302 Children and Adolescents in a Metropolis of Yangtze River Delta, China.

Objectives This study aimed to compare performances of China reference and different national references on high blood pressure (HBP). Methods A cross-sectional study including 695,302 children and adolescents aged 7 to 17 years in Suzhou, China, was conducted to determine the prevalence of HBP based on U.S., international, Europe, and China references in 2016. Results Different percentiles of height and blood pressure were found among four references. Referring to U.S. reference, the prevalence of HBP was the highest with 26.0%, followed by International reference with 20.0%, Europe reference with 19.5%, and China reference with 19.2%. McNemar tests indicated statistically significant differences between HBP prevalence comparing China reference with the other 3 references (P < 0.001). The area under the curve was 0.947, 0.851, and 0.949 for U.S., international, and Europe reference, respectively. U.S. reference showed the highest sensitivity (98.2%), but the lowest specificity (91.2%), and Europe reference showed the highest kappa value (0.893). Conclusions The prevalence of HBP varied among these four references, and the appropriate choice of reference would be important to recognize high-risk children and judge the trends of HBP prevalence in the targeted population.

Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study.

Aims/hypothesis: The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data. Methods: Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children’s carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment. Results: A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist. Conclusions/interpretation: Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.

Anthropometric indices of obesity as predictors of high blood pressure among school children

ABSTRACT Background Hypertension is related to increased body fat, which can be evaluated by anthropometric indicators. The aim of this study was to determine the predictive power of anthropometric indicators and to establish their cutoff points as discriminators of high blood pressure. Methods A cross-sectional study was conducted on 793 schoolchildren aged 10–14 years. Six anthropometric indices were used: body mass index-z-score (BMI-z-score), waist circumference (WC), waist-toheight ratio (WHtR), a body shape index (ABSI), body roundness index (BRI) and conicity index (CI). Elevated blood pressure (EBP) and hypertension (HTN) were characterized by values ≥ 90th and <95thpercentile and ≥ 95th percentile for systolic and/or diastolic blood pressure, respectively. The predictive power of anthropometric indices was analyzed by sex using the receiver operating characteristic curve(ROC). Results The prevalence of EBP and HTN was 11.0% and 14.8%, respectively. According to the analyses of the ROC curve, WC provided the largest area under the curve (AUC) value, while CI showed the lowest AUC value in predicting elevated blood pressure in the total sample. The BMI z-score provided the largest area under the curve (AUC) value (0.722), followed by WHtR (0.709) and BRI (0.709), in predicting hypertension in boys. Conclusions BMI z-score and WC may be the best predictors of EBP and BMI z-score for HTN among Jordanian schoolchildren.

The Relation between Vitamin D Levels and Cardiovascular Comorbidities in Obese Children

Abstract Background Childhood obesity is accompanied by increased cardiovascular co morbidities and vitamin D deficiency. However, the relation between vitamin D deficiency and cardiovascular comorbidities remains uncertain. Objectives We aim to determine if there is an association between vitamin D deficiency and cardiovascular risks in obese children. Patients and Methods A case control study was conducted on 63 prepubertal patients with simple obesity recruited from the pediatric obesity clinic, Ain Shams University. They were divided into 2 groups: 33 cases with deficient 25(OH) D (&amp;lt; 20ng/ml) and 30 with sufficient 25(OH) D (≥ 20ng/ml). Both groups were subjected to full history taking, general examination including blood pressure, anthropometric measurements and laboratory evaluation including lipid profile, thyroid profile and glucose homeostasis parameters. Results There was a positive correlation between 25(OH) D and HDL cholesterol (r = 0.407, p = 0.026). Obese children with deficient 25(OH) D had significantly higher diastolic blood pressure percentiles (86.20 ±9.20 in deficient vs 78.44±15.50 in sufficient, p = 0.018). Conclusion A possible relationship exists between obesity related comorbidities and vitamin D status. Further studies should focus on the effect of vitamin D deficiency on obesity related comorbidities.

Prevalence of Obesity and Hypertension among Rural School Adolescents: A School Based Pilot Study in Kerala, India

Aim: The prevalence of hypertension and obesity is increasing worldwide. Recent data on sustained hypertension and obesity among school-going children and adolescents from the state of Kerala, India are limited. The aim of the present study was to estimate the prevalence of obesity and hypertension among apparently healthy school going adolescents.&#x0D; Methodology: A cross-sectional survey was conducted among 252 school going adolescents aged 11-16 years (173 boys and 79 girls) selected from two private aided rural schools of Thrissur, District, Kerala, India. Measurements like height, weight, and blood pressure were done using standard guidelines. Guidelines of Indian Academy of Pediatrics and standard guidelines of blood pressure measurement using gender height specific blood pressure percentile charts were used to identify the overweight/obese and pre-hypertensive/ hypertensive adolescents respectively. Analysis was done using SPSS version 27.0. Gender wise differences were checked using chi-square and t-test.&#x0D; Results: Among 252 adolescents, 83 (20.7%) were either overweight or obese and pre-hypertensive or hypertensive. The overall prevalence of obesity and overweight was found to be 9.5% and 15.1% respectively. The overall prevalence of hypertension and prehypertension was found to be 15 (6.0%) and 24 (9.5%) respectively. Systolic blood pressure and diastolic blood pressure was found to be statistically lower (P&lt;0.001) among those with normal BMI, than those with overweight or obesity. The mean systolic and diastolic BP was slightly more among boys than girls and it was not statistically significant.&#x0D; Conclusion: The high prevalence of hypertension, obesity and the strong association between obesity and high blood pressure seen among school-going adolescents necessitates immediate attention. Strategies should be designed and implemented for prevention, early identification, and treatment of pediatric obesity and hypertension in forestalling the morbidity/mortality from non communicable diseases and its complications.

Sleep apnoea-hypopnoea syndrome in the obese and non-obese: Clinical, polysomnographical and clinical characteristics

IntroductionSleep apnoea-hypopnoea syndrome (SAHS) and childhood obesity are two high prevalence conditions that represent a public health challenge. ObjectiveTo analyse the association between both and comparing child groups that had or did not have both conditions. Patients and methodsA prospective study in children (3–14 years), referred to the “Multidisciplinary Sleep Unit” due to suspected SAHS, between 1 November 2015 and 1 August 2017. The following parameters were evaluated: anthropometry, symptoms, blood pressure, ear, nose, and throat examination, polysomnography (nocturnal PSG) and laboratory tests. ResultsA total of 67 children were evaluated (64% non-obese (NOb) and 36% obese (Ob). It was observed that the Ob were older (P < .001), slept less hours (P = .028), did less physical exercise (P = .029), ate less in the school dining room (P = .009), had la lower sleep efficiency, and had abnormal values in carbohydrate and lipid metabolism.The children with SAHS were younger (P = .010), a high percentage of daytime sleepiness (P = .001), and breathing through the mouth (P = .006), greater percentile of diastolic blood pressure (P = .019) and a lower IGF-1 (P = .003) than those that did not have SAHS. The comparison of the SAHS NOb and SAHS Ob groups, showed that the first group were younger (P = .010), snored more (P = .012), had a more severe SAHS (IAH 13.1 vs 5.4, P = .041), and a higher GOT (P < .001). In the second group, they slept less hours P = .038) and showed lower values of glucose (P = .039), insulin (P < .001), and HOMA (P < .001). ConclusionThe behaviour of SAHS is different in obese children and non-obese children, with differences in age, clinical characteristics, severity of SAHS, and metabolic changes. The children diagnosed with SAHS were in the higher percentile of diastolic blood pressure. Obesity was associated with worse sleep quality, and changes in carbohydrate and lipid metabolism.

Association of Placental Pathology With Childhood Blood Pressure Among Children Born Preterm.

The in utero pathologies underlying the link between preterm birth and offspring high blood pressure (BP) are still unknown. We investigated the prospective associations of placental histopathological findings with childhood BP among children born preterm. Our study sample included 546 mother-child pairs with preterm birth (before 37 weeks gestation) enrolled from 1999 to 2013 at the Boston Medical Center. Early preterm birth was defined as gestational age between 23 and 34 weeks. We histologically classified maternal placental pathology using the latest recommended categories: no placental complications, histologic chorioamnionitis, maternal vascular malperfusion, and other placental complications. We calculated age-, sex-, and height-specific systolic BP (SBP) percentiles for children using the 2017 American Academy of Pediatrics Clinical Practice Guideline. We used linear regression models with generalized estimating equations to examine the associations. The mean (standard deviation (SD)) postnatal follow-up of the study children was 9.29 (4.1) years. After adjusting for potential confounders, histologic chorioamnionitis was associated with a 5.42 percentile higher childhood SBP (95% confidence interval: 0.32, 10.52) compared with no placental pathologic findings. This association was stronger among early preterm children. Maternal vascular malperfusion was associated with a 8.44 percentile higher childhood SBP among early preterm children (95% confidence interval: 1.54, 15.34) but the association was attenuated (6.25, 95% confidence interval: -0.76, 13.26) after additional adjustment for child standardized birthweight, a potential mediator of the association. These findings suggest that among children born preterm, especially those born early preterm, both placental histologic chorioamnionitis and vascular malperfusion may help to differentiate a child's risk of high BP.

Oxidative stress in youth with type 1 diabetes: Not only a matter of gender, age, and glycemic control

AimsWe assessed whether oxidative stress (OS) is increased in children/adolescents with type 1 diabetes (T1D) compared to healthy peers. Moreover, we searched for OS predictors in the T1D population. MethodsWe compared the concentration of serum derivatives of reactive oxygen metabolites (d-ROMs) in 412 children/adolescents with T1D (3.6–23.5 years old) to that of 138 healthy children/adolescents (1.2–19.2 years old) by ANOVA adjusted for age, gender, and BMI z-score (z-BMI). Applying a general linear model, in a subgroup of 331 patients using continuous glucose monitoring, we searched for predictors of d-ROMs among 3-day, 2-week, and 4-week metrics of glucose control and variability, such as mean blood glucose, percent time in range (70–180 mg/dl,TIR70-180), coefficient of variation, and others, as well as among conventional cardiovascular risk factors like current and average HbA1c, z-BMI, blood pressure percentiles, and lipid concentrations recorded retrospectively over the entire follow-up period. ResultsD-ROMs levels were significantly higher in children/adolescents with T1D compared to controls [371.9 (64.2) versus 324.9 (46.3), p < 10−16]. Sex (B = 49.1, ƞ2 = 0.14, p = 1.3 * 10−9), age < 12 years in boys (B = 79.4, ƞ2 = 0.074, p = 10−7),3-day TIR70-180 (B = -0.87, ƞ2 = 0.048, p = 6.5 * 10−5), and z-BMI (B = 7.4, ƞ2 = 0.016, p = 0.022) predicted d-ROMs with an overall R2 of 0.278. ConclusionsOS is increased in youth with T1D and only partially predicted by gender, age, glucose control, and anthropometry. Other potential determinants of OS in this population should be targeted in future studies.

Influence of Blood Pressure Percentile Reporting on the Recognition of Elevated Blood Pressures.

To explore the impact of displaying blood pressure (BP) percentiles with BP readings in the electronic health record (EHR) on the recognition of children with elevated blood pressures (EBPs). This was a retrospective cohort study of children (ages 1-17), including inpatients and outpatients, with at least 1 EHR noninvasive BP recording. In phase 1, BP percentiles were calculated, stored, and not displayed to clinicians. In phase 2, percentiles were displayed adjacent to the EHR BP. Encounters with 1 BP ≥95th percentile were classified as elevated. EBP recognition required the presence of at least 1 EBP-related International Classification of Diseases, Ninth Revision or International Classification of Diseases, 10th Revision code. We compared recognition frequencies across phases with logistic regression. In total, 45 504 patients in 115 060 encounters were included. Inpatient recognition was 4.1% (238 of 5572) in phase 1 and 5.5% (338 of 5839) in phase 2. The adjusted odds ratio (OR) associated with the intervention was 1.22 (95% confidence interval [CI]: 0.90-1.66). Outpatient recognition rates were 8.0% (1096 of 13 725 EBP encounters) in phase 1 and 9.7% (1442 of 14 811 encounters) in phase 2. The adjusted OR was 1.296 (95% CI: 0.999-1.681). Overall, recognition rates were higher in boys (outpatient OR: 1.51; 95% CI: 1.15-1.98) and older children (outpatient/inpatient OR: 1.08/1.08; 95% CI: 1.05-1.11/1.05-1.11) and lower for those on a surgical service (outpatient/inpatient: OR: 0.41/0.38; 95% CI: 0.30-0.58/0.27-0.52). Addition of BP percentiles to the EHR did not significantly change EBP recognition as measured by the addition of an EBP diagnosis code. Girls, younger children, and patients followed on a surgical service were less likely to have their EBP recognized by providers.

Evaluation of Gender, Body Mass Index and Blood Pressure Percentiles in Primary School Students

Özet&#x0D; Amaç: Bu araştırmanın amacı Mersin’in merkezinde bulunan bir ilköğretim okulu öğrencilerinin cinsiyete göre vücut kitle indeksi ve kan basıncı persentillerini obezite ve hipertansiyon riski açısından değerlendirmektir.&#x0D; Yöntem: Tanımlayıcı-ilişki arayıcı bir çalışmadır. Çalışma ailesinden yazılı izin formu alınan 755 öğrenciyle yürütülmüştür. Öğrencilere ait ölçümler araştırmacılar tarafından yapılmıştır. Vücut Kitle İndeksi ve Kan basıncı persentilleri açısından öğrenciler değerlendirilmiştir. &#x0D; Bulgular: Araştırmaya katılan 755 öğrencinin %49,9’u erkektir. Çalışmaya katılan erkek öğrencilerin ise %21’i obezdir. Sistolik ve diyastolik kan basıncı persentili 95 üstü olan kız öğrencilerin oranı sırasıyla %8 ve %10’dur. Erkek öğrencilerde ise sistolik ve diyastolik kan basıncı persentili 95 üstü olan oranı sırasıyla %8 ve %7’dir. Çalışmamızda Vücut Kitle İndeksi persentilleri ile kan basıncı persentilleri arasında anlamlı bir ilişki bulunmuştur (p

Cardiorespiratory Fitness Associates with Blood Pressure and Metabolic Health of Children-The Arkansas Active Kids Study.

High blood pressure (HBP) in children causes preclinical damage to the heart and accelerates atherosclerosis. Current pharmacological treatments have limited ability to prevent end-organ damage, particularly that of the kidneys. A contrasting element between adult versus pediatric HPB treatment is the emphasis in adults on exercise regimens that target increments in cardiorespiratory fitness (CRF; peak oxygen consumption [V˙O2peak]). The aim of this study was to evaluate the association of CRF with blood pressure percentiles and blood pressure status in children with normal and excessive adiposity (NA vs EA). An exploratory aim was to measure associations of CRF with (a) other cardiovascular disease risk factors commonly found in children with HBP and (b) kidney function. Children (n = 211) attended one study visit. CRF was measured using an incremental bike test and body composition by dual-energy x-ray absorptiometry. Fat-free mass (FFM) index was calculated as kilograms of FFM per square meter. Multiple logistic and linear regression analyses were used to model the probability of HBP and other variables of interest (plasma lipids, HOMA2-IR, alanine aminotransferase, and estimated glomerular filtration rate) against V˙O2peak. CRF interacted with adiposity status in predicting the probability of HBP. Each additional milliliter per minute per FFM index in V˙O2peak decreased the odds of HBP by 8% in the EA group only (odds ratio = 0.92, 95% confidence interval = 0.87-0.99). Systolic and diastolic blood pressure percentiles decreased, and estimated glomerular filtration rate increased with increasing CRF in both adiposity-level groups. HOMA2-IR and alanine aminotransferase decreased with increasing CRF in children with EA only. Higher CRF associated with decreased probability of clinical HBP, lower insulin resistance, and improved liver function in children with EA. Yet blood pressure percentiles and kidney function improved with increasing CRF irrespective of adiposity status.

Blood pressure percentiles and systemic hypertension-associated factors among children aged between 6 and 15 years in Southern Vietnam

Background: The present study determined blood pressure percentiles in children aged between 6 and 15 years in Southern Vietnam. Material and methods: Blood pressure was measured in a random sample of 1080 students aged 6–15 years who was studying at primary and secondary high schools in My Tho city, Vietnam. A descriptive cross-sectional study was conducted from November 2019 to June 2020. To diagnose children systemic hypertension, the blood pressure must be above the 95 th percentile. Data were analyzed by IBM SPSS statistics software version 20.0. The Chi-squared test was employed to evaluate the relationship between systemic hypertension and child demographic characteristics including gender and obesity. Results: The results showed that the 95 th percentiles of systolic and diastolic blood pressure of the children was 110/70 mm Hg in the 6-year-old group, 120/75 mm Hg in the 7 to12-year-old group and 125/80 mm Hg in the 13 to 15-year-old group, respectively. The rate of systemic hypertension in the children was 10% whereas boys had a 1.2 time higher risk of systemic hypertension than girls (p &gt; 0.05). Obese children had an 8.6 time higher risk of systemic hypertension than non-obese ones (p &lt; 0.001). Conclusion: The blood pressure percentile chart of school children aged 6–15 years were reported here for the first time in Vietnam. The results provided useful information in early diagnosis and timely treatment of systemic hypertension in children.

Predictors of Platelet Mitochondria Respiration in Children – The Arkansas Active Kids Study

ObjectivesPlatelets play a critical role in the pathogenesis of atherosclerotic disease (AD). In the absence of a nucleus, platelet function and viability are largely dependent on the health of their mitochondria. The purpose of this study was to evaluate the association between common markers of cardiometabolic health in 7 to 10-year-old children and measures of platelet mitochondria function. MethodsSixty children participated in a single study visit. Fasting blood was collected, and cardiorespiratory fitness (CRF, cycle ergometer test), physical activity (PA, accelerometers), and blood pressure percentiles were determined. Routine respiration (R) was measured by high-resolution respirometry (Oxygraph-2k) before platelets were permeabilized by digitonin. Thereafter, Complex I (CI) supported respiration was assayed in the leak (L), coupled (P) and uncoupled (CIE) states. Complex IV (CIV) activity was assayed as a marker of respiratory capacity. Flux control ratios (FCR) were calculated by dividing respiratory fluxes by CIV. Multiple linear regression analyses were used to model FCRs (dependent variables) with age, sex, race, CRF, PA, Body Mass Index (BMI) percentile, HOMA2-IR, systolic (SBP-P)/diastolic blood pressure percentiles (DBP-P), triglyceride status, and Low Density Lipoprotein (LDL) status (status = high vs. normal) as dependent variables. ResultsAge, race, LDL status and the interaction between BMI percentiles with SBP-P were retained in the final regression models for R, L, P and CIE FCRs. Specifically, R and CI supported respiration in the L, P and CIE states decreased with age (P < .05), black race (P < .05), and high LDL-cholesterol status (P < .0001). To assess for the interaction between BMI and SBP-P, children were stratified as normal weight (NW) or overweight (OW = BMI ≥ 85th percentile) with high (≥90th percentile) or normal SBP. FCRs did not differ between NW groups. However, FCRs where ∼2 times higher in children with OW + high SBP compared to children with OW + normal SBP (P < 0.05). ConclusionsAge, race, LDL cholesterol status, and systolic blood pressure are determinants of platelet bioenergetics in children. SBP-P modifies the association between weight status and platelet mitochondria respiration. Funding SourcesUSDA-ARS 59-6250-4-001 and 6026-51,000-012-06S. NIH-NIGMS 5P20GM10909, NIH 8UG1OD024945, NIH-NCATS 1UL1TR003107-0.