Diastolic Blood Pressure In Children Research Articles

Potential impact of severe hydronephrosis secondary to ureteropelvic junction obstruction on pediatric blood pressure

Hydronephrosis could affect blood pressure (BP) according to published case reports and animal experiments. The impact on pediatric BP is often overlooked due to children's inherently lower BP, superior vascular elasticity and greater resistance to hypertension than adults. This study aimed to prospectively observe the effects of hydronephrosis, secondary to ureteropelvic junction obstruction (UPJO), on pediatric BP. Children with hydronephrosis secondary to UPJO who required pyeloplasty were categorized into five age groups: neonates, infants, toddlers, preschoolers, and school-aged children. Preoperative and postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were compared among these age groups, followed by comparison with a control group of children without nephritis or cardiovascular conditions. The impact of severe hydronephrosis secondary to UPJO on pediatric BP and its association with the renin-angiotensin-aldosterone system (RAAS) were examined. This study enrolled 114 children with severe hydronephrosis secondary to UPJO and 153 without nephritic or cardiovascular conditions between September 2021 and June 2023. As the control group aged, SBP and DBP increased, whereas ARC and AC decreased. Overall, hydronephrosis group had higher SBP, DBP, ARC, and AC than the controls group. These differences differed between the age groups. After pyeloplasty, the postoperative BP of hydronephrosis group approximated that of the control group. Postoperative ARC levels were higher than those in the control group but were much lower than the preoperative levels. AC did not decrease significantly after surgery. The change in DBP in children with hydronephrosis before and after pyeloplasty showed a positive correlation with the change in AC. Pediatric patients with severe hydronephrosis, a condition secondary to UPJO, displayed elevated BP, ARC, and AC. Following pyeloplasty, these patients noted a reduction in BP. The correlation between elevated blood pressure and the RAAS necessitates further comprehensive investigation.

Abstract P410: Association Between Maternal Magnesium and Offspring Blood Pressure at 4 Years of Age: A Birth Cohort Study

Background: The potential influence of maternal magnesium levels during gestation on offspring's blood pressure remains largely unexplored. Objective： We aim to investigate the association of maternal magnesium concentrations during early pregnancy and child’s blood pressure at four years of age. Methods: Using data from the Shanghai Birth Cohort, this study analyzed the data from 1129 mother-child pairs. Results: Maternal blood magnesium concentrations were inversely associated with blood pressure of offspring at 4 years of age. Each 1mmol/L increment in maternal magnesium was correlation with 3.03 mmHg (95% CI -4.77 to -1.29, P =0.001) decrease of systolic blood pressure and 1.72 mmHg (95% CI -3.22 to -0.23, P =0.024) decrease of diastolic blood pressure in children after adjusting for covariates. Moreover, maternal magnesium concentrations were associated with incident high blood pressure (OR = 0.40, 95% CI, 0.17 to 0.95, P =0.037) of offspring. Exploratory maternal pre-pregnancy body mass index stratified analyses found that the negative regression coefficient (β) of maternal magnesium and child blood pressure was greater in the overweight/obese group than in normal weight group or underweight group ( P for systolic blood pressure difference 0.014, P for diastolic blood pressure difference 0.019). Conclusions: Our data suggest higher maternal magnesium concentrations are associated with lower blood pressure levels and reduced risk of high blood pressure in children. Our findings highlight the importance of maternal Mg levels during pregnancy, especially for the mothers who are overweight or obese.

Efeitos de intervenções de base escolar na pressão arterial de crianças com obesidade: metanálise

Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA), a systematic review with metanalysis was conducted to identify and summarize the effects of school-based physical activity interventions that sought to control and / or reduce blood pressure (systolic and diastolic) in children and / or adolescents with overweight and / or obesity. In September 2022, potential studies were searched in five electronic databases (Pubmed, Scielo, Scopus, Sportdiscus, and Web of Science) and in reference lists. Randomized controlled trials conducted in schools with interventions involving physical activity and assessment of systolic and diastolic blood pressure in children and adolescents aged 6 to 19 years with overweight and / or obesity were considered for synthesis. The risk of bias was assessed using an adapted version of the Effective Public Health Practice Project tool (EPHPP). Metanalysis was developed from the random model. Four studies were included. For systolic blood pressure, a summary effect of -0.10 (95% CI: -0.39; 0.19; I2 = 0%) was observed. For diastolic pressure, the metanalysis indicated -0.33 (95% CI: -0.62; -0.04; I2 = 11%). Considering the promising effects on diastolic blood pressure, we suggest the development of more school-based interventions based on physical activity practice for overweight and / or obese populations, which may also add environmental elements, longer duration, multicomponent approaches, and parent / guardian involvement to their strategies.

Association between prenatal metals exposure and blood pressure in 5–6 years children: A birth cohort study

BackgroundThe trajectory of blood pressure (BP) from childhood to early middle age suggested that individuals with elevated BP in early childhood were more likely to be affected by cardiovascular disease in adulthood. Exposure to metals may affect BP in children, and pregnancy is a sensitive time for metal exposure. This study assessed the relationship between different stages of prenatal exposure to metals or metal mixtures and BP in children aged 5–6 years. MethodsThe study included 2535, 2680, 2534 mother-child pairs in three trimesters, from the Ma'anshan birth cohort study (MABC). We collected maternal blood samples during pregnancy and measured the serum levels of four metals (arsenic, selenium, cadmium, and mercury). BP was measured in children aged 5–6 years. A linear regression model and Bayesian kernel machine regression (BKMR) were used to explore associations between prenatal exposure to metals at different stages and multiple metal exposure with BP in children aged 5–6 years. ResultsAssociations were observed between the arsenic in the third trimester and children's diastolic blood pressure (DBP) (β = 0.88, 95% CI: 0.44, 1.33), systolic blood pressure (SBP) (β = 0.72, 95% CI: 0.19, 1.24) and mean arterial pressure (MAP) (β = 0.83, 95% CI: 0.42, 1.23), as well as between the mercury and children's DBP (β = 0.65, 95% CI: 0.13, 1.16) and MAP (β = 0.60, 95% CI: 0.14, 1.07). The BKMR analysis showed that multiple metals had a significant positive joint effect on children's DBP, SBP and MAP. A potential interaction between arsenic and mercury was observed (β = −0.85, 95% CI: −1.62, −0.08). ConclusionsExposure to arsenic and mercury during pregnancy was associated with altered BP in children. The third trimester may represent an important window of opportunity to reduce the effects of metal exposure on children's blood pressure and long-term health.

Birth weight influences differently on systolic and diastolic blood pressure in children and adolescents aged 8–15

AimGlobally, hypertension is one of the main threats to public health and a significant risk factor predisposing individuals to various cardiovascular conditions. Hypertension in the young is particularly complex and challenging. Accumulating evidence has implicated that low birth weight is vital for elevated blood pressure, and birth weight was negatively correlated with blood pressure. However, fewer studies with conflicting results have addressed the associations between birth weight and blood pressure in children and adolescents, and there is no relevant research conducted in the NHANES population. The principal objective of this project was to investigate the relationship between birth weight and blood pressure in children and adolescents in NHANES.MethodsA total of 7600 subjects aged 8 to15 were enrolled in the present study from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Outcome variables were systolic blood pressure(SBP) and diastolic blood pressure(DBP). Birth weight was regarded as an independent variable. EmpowerStats software and R (version 3.4.3) were performed to examine the association between birth weight and SBP or DBP.ResultsBirth weight was negatively correlated with SBP in the fully-adjusted model(β = -0.02, 95%CI: -0.04 to -0.04, p = 0.0013), especially in non-Hispanic White (β = -0.03, 95%CI: -0.06 to -0.00,p = 0.0446), aged between 13 to 15(β = -0.03, 95%CI: -0.04 to -0.01, p = 0.0027), and male individuals(β = -0.03, 95%CI: -0.05 to -0.01, p = 0.0027). However, there was no unidirectional association between birth weight and DBP in the fully adjusted model(β = -0.01, 95%CI: -0.03 to 0.02, p = 0.5668) and in sub-analysis. An inverted U-shaped and J-shaped relationship was uncovered between birth weight and DBP in those aged 13 or above and Mexican Americans, respectively. The inflection point calculated by a recursive algorithm of birth weight in these groups was all 105 oz.ConclusionsThe current study identified that birth weight was negatively related to SBP but not significantly related to DBP in children and adolescents aged 8 to 15, highlighting different potential mechanisms behind high SBP and high DBP in the young. However, an inverted U-shaped and J-shaped relationship between birth weight and DBP was observed, suggesting that targeted intervention measures should be taken for different groups of people rather than generalizations.

Effectiveness of music during cardiac catheterization on children's pain, fear, anxiety and vital signs: A randomized, blind controlled trial

PurposeThis study aims to examine the effectiveness of music during pediatric cardiac catheterization procedure on children's pain, fear, anxiety and vital signs. Design and methodsThis randomized, blind controlled study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The sample of children was allocated to the Control Group, the Classic Music Group, and the Self-Selected Group. Pain, fear, and anxiety levels were measured before and after the pediatric cardiac catheterization procedure. Vital signs were measured before, during, and after the pediatric cardiac catheterization procedure. ResultsThere was no significant difference between the groups in terms of demographic status, pain, fear, or anxiety levels and vital signs before the procedure. In post pediatric cardiac catheterization measurement in the recovery phase, pain, fear levels, anxiety levels, heart rate, systolic and diastolic blood pressure of children in the musical intervention groups were lower than the control group. No statistical difference was found in terms of pain, fear and anxiety levels of the children in groups Classic and Self-Selected. Conclusion and practice implicationsThe result of this research reveals that musical intervention applied during the pediatric cardiac catheterization procedure in children affects the reduction of pain, fear and anxiety levels and stabilization of vital signs. This intervention could be an effective nonpharmacological method to improve outcomes.Nurses can improve children's comfort by using musical interventions.Clinical Registration: This study was registered at the U.S. National Library of Medicine Clinical Trials (code: NCT04316754).

Hemoglobin and hematocrit levels are positively associated with blood pressure in children and adolescents 10 to 18\xa0years old

To investigate the associations between hemoglobin (Hb) concentration and hematocrit (Hct), and blood pressure (BP) in children and adolescents. The study population consisted of 7950 subjects total (4229 boys and 3721 girls) aged 10–18 years who participated in the Korea National Health and Nutrition Examination Surveys conducted between 2007 and 2017. The prevalence of hypertension was 19.19% (21.51% for boys and 16.5% for girls) among the study population, and the prevalence of obesity was 9.59% (10.5% for boys and 8.6% for girls). Hb count and Hct tended to increase with the degree of obesity and BP elevation. Systolic BP (SBP) and diastolic BP (DBP) positively correlated with Hb count and Hct in both sexes. Following multiple linear regression analysis, Hb count and Hct presented a positive association with SBP and DBP after adjusting for age, BMI SDS, alcohol consumption, smoking status, physical activity, rural residence, household income, diagnosis of T2DM, hypertension, and dyslipidemia. Hb count and Hct were positively associated with SBP and DBP in children and adolescents 10–18 years old.

Relationship between Serum 25(OH)D Levels and Blood Pressure in Children with Nephrotic Syndrome

BACKGROUND: Vitamin D plays an eminent role in the renin-angiotensin system that may interfere with blood pressure regulation. Children with nephrotic syndrome (NS) are often observed with low serum vitamin D levels that may lead to Vitamin D deficiency status. AIM: This study aimed to investigate the correlation between serum vitamin D [25(OH)D] levels and blood pressure in children with NS. METHODS: A cross-sectional, observational analytic study was conducted in 35 children NS with minimal change diseases from February to August 2019 in Haji Adam Malik General Hospital, Medan. Blood pressure was examined and serum Vitamin D levels along with serum creatinine, albumin, and calcium were measured. RESULTS: Of 35 children, 21 children (60%) had proteinuria. Regarding the category of Vitamin D status, there were 40% and 34.3% with deficiency and severe deficiency of Vitamin D, respectively. The median serum Vitamin D levels were not significantly different among the age group. Children with proteinuria showed lower serum Vitamin D levels (P < 0.001). There was an elevation of systolic and diastolic blood pressure in children with proteinuria (P = 0.039 and P = 0.036, respectively). Our study showed a weak negative correlation between serum Vitamin D levels and either systolic or diastolic blood pressure (r-0.114 and r-0.174, respectively). CONCLUSION: Both Vitamin D deficiency and severe deficiency are common in children with NS. In this study, serum Vitamin D levels have been shown to have a weak negative correlation with blood pressure in children with NS.

STATE OF SYSTEMIC HEMODYNAMICS FOR CHILDREN WITH CONGENITAL SURGICAL PATHOLOGY IN DIFFERENT COMBINED ANESTHESIA TYPES

General anesthesia for a surgical correction of congenital malformations in children is accompanied, in particular, by the disorders of systemic hemodynamics. In order to assess the impact of different types of combined anesthesia on the state of systemic hemodynamics in surgical correction of congenital malformations, a retrospective study of the treatment of 150 newborns and infants was conducted. These were children with various congenital malformations, but the most common were intestinal obstruction and abdominal tumors. Three groups of patients were formed depending on the type of combined anesthesia during surgical correction of abnormalities: I − inhalation (sevorane) + regional anesthesia; II − inhalation (sevorane) + intravenous anesthesia (fentanyl); III − total intravenous anesthesia with two drugs: analgesic (fentanyl) and drug sleep on the background of intravenous injection of hypnotics (20 % sodium oxybutyrate). There were preformed the surgeries: thoracic, urological, abdominal. The study was retrospectively evaluated in five stages. The analysis of systemic hemodynamics showed a tendency to reduce diastolic blood pressure in children treated with anesthesia with two intravenous drugs (hypnotic and fentanyl), during all observation stages and a significant decrease in this index at the most painful and traumatic period. At the time of induction of anesthesia in children there was a decrease in heart rate. According to the research results, it is concluded that when using the pre−hypnotics as part of combined anesthesia in children with congenital malformations during surgery there is a risk of complications from central hemodynamics in the form of vasodilation, which leads to a drop in blood pressure and increases compensatively the heart contractions. Key words: infants, congenital malformations, anesthesia, hemodynamics.

The Effect of Dietary Approaches to Stop Hypertension on Weight, Body Composition, and Blood Pressure of Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Clinical Trial

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children. Children with ADHD usually have low blood pressure and weight disorders. Therefore, the present randomized clinical trial was conducted to evaluate the effect of Dietary Approaches to Stop Hypertension (DASH) on weight and blood pressure of children with ADHD. Methods: In this research, 86 children aged 6 to 12 years with diagnosed ADHD according to Conner’s Teacher's Questionnaire and DSM-4 criteria were investigated. Participants were randomly assigned into two groups to receive a DASH diet and a control diet for 12 weeks. Participants' anthropometric indices, blood pressure, physical activity, and dietary compliance were evaluated each month. Adherence to the diet was studied using a three-day food report completed by the participants' parents. Results: A total of 80 children completed the study (40 in each group). No significant difference was observed in any of the weight composition indices measured before and after the intervention between the study groups (P > 0.05). No significant difference was reported in the systolic and diastolic blood pressure between the study groups at the baseline. However, diastolic blood pressure increased in the DASH group significantly compared to the control group (P = 0.02). Conclusion: The DASH diet might increase the diastolic blood pressure in children with ADHD. Further studies with a longer follow-up period are necessary to confirm these results.

Vitamin D Supplementation and Blood Pressure in Children and Adolescents: A Systematic Review and Meta-Analysis.

Suboptimal vitamin D status is associated with elevated blood pressure (BP) in children and adolescents. Whether vitamin D supplementation reduces BP remains unclear. To systematically review whether vitamin D supplementation reduces BP in children and adolescents, we conducted a literature review according to the PRISMA statement. We included vitamin-D supplementation human interventions studies that reported on BP as an outcome. We searched PUBMED, MEDLINE, CINAHL, EMBASE, the Cochrane Library, and the clinical trials website. We also hand searched the references of the included articles and previous reviews of vitamin D therapy. No language or time restrictions were applied. We extracted data on population characteristics, baseline and endline vitamin D and BP values, and assessed the risk of bias of the included studies. We performed a narrative review of the findings, conducted a meta-analysis when possible, and performed sensitivity analyses to test the robustness of our results. We assessed the overall quality of the evidence produced in the meta-analysis. We included eight studies in our review and five studies in the meta-analysis, none of which included hypertensive only participants. The risk of bias was variable. In non-randomized studies, no effect of vitamin D supplementation was seen on systolic BP (SBP) (mean difference: 0.39 (95% confidence interval (CI): −0.9; 1.68) mmHg; p = 0.55; I2 = 0%). Only a significant decrease in diastolic BP (DBP) (mean difference: −1.87 (95% CI: −3.02; −0.72) mmHg; p = 0.001; I2 = 0%) was noted. Both analyses had a low quality of evidence. In randomized controlled trials (RCTs), no effect was noted on SBP (mean difference: −2.04 (95% CI: −5.12; 1.04) mmHg; p = 0.19; I2 = 71%) nor DBP (mean difference: 0.01 (95% CI: −1.09; 1.12) mmHg; p = 0.98; I2 = 0%). The final quality of evidence ranged between low and moderate. Sensitivity analyses did not affect the results. Vitamin D supplementation was found to be ineffective in lowering SBP and DBP in children and adolescents.

Reliability of normative tables in assessing elevated blood pressure in children.

Epidemiological studies indicate that elevated blood pressure (BP) is common among children. Early detection of elevated BP in children is important in the prevention of cardiovascular disease (CVD). Difficulties exist in the diagnosis of "elevated" BP in children of 8-12 years of age. Normative tables of sex, age, and height specific BP percentile levels are required. Reports provide normative tables of BP percentile levels in children. Elevated BP is defined as systolic and diastolic BP ≥ 90th age, sex, and height specific BP percentile. The study tests the internal consistency and reliability between the normative tables of BP in children. The main objective of the study is to assess the reliability of existing normative tables of BP in children by using ad hoc analysis of a prior survey. A cross-sectional survey was performed in elementary school children (8-12 years of age, n = 818) from Istanbul, Turkey. The survey was conducted in 2007-2008. Four different normative tables of BP were used to determine children with elevated BP. The reliability and internal consistency between the normative tables of BP in children were assessed. The prevalences of elevated systolic and diastolic BP in children differed significantly between the normative tables of BP. The internal consistency between the normative tables was poor (Cronbach α coefficient = 0.429). Kuder-Richardson 21 test indicated poor reliability between the local and international normative tables of BP. In conclusion, the study indicates that there are significant inconsistencies and poor reliability between the national and international normative tables of BP in children.

Salusin-α levels are negatively correlated with diastolic blood pressure in children with obesity.

Salusins have emerged as a new biomarker that reflects an increased inflammatory state, which is associated with cardiovascular risk. We investigated the predictive value and usefulness of salusins as an inflammatory biomarker in obese children. This prospective cohort study included 75 obese children and 101 healthy children (as a control group). Salusin-α, Salusin-β, and various cardiovascular parameters were assessed in both groups. Correlation analyses of Salusin-α and Salusin-β with body mass index standard deviation scores and inflammatory and cardiovascular markers were performed. The mean patient age was 11.9±2.4 years for the obese group and 12.5±2.1 years for the control group. The obese children had a significantly higher heart rate, systolic blood pressure, diastolic blood pressure, epicardial adipose tissue thickness, and left ventricular mass than did the children in the control group. There was no significant correlation between Salusin-α and Salusin-β and body mass index; however, there was a negative correlation between Salusin- α and diastolic blood pressure (r = 0.277, p = 0.004). Overall, there was no significant difference in the Salusin-α and Salusin-β levels between obese and healthy children. However, a negative correlation was found between Salusin-α and diastolic blood pressure. Although this result suggests that Salusin-α might be an early marker of cardiovascular involvement in obese children, further studies are needed to demonstrate the predictive value of salusins.

A13796 Using K4 and K5 diastolic blood pressure in children as a predictor for subclinical vascular damage in adulthood

A13796 Using K4 and K5 diastolic blood pressure in children as a predictor for subclinical vascular damage in adulthood

Handgrip Strength and Blood Pressure in Children and Adolescents: Evidence From NHANES 2011 to 2014.

Previous studies have reported that handgrip strength, a measure of muscular fitness, is associated with cardiovascular risk factors. However, the association of handgrip strength with blood pressure (BP) in children has been inconsistent. We tested the association of handgrip strength with systolic and diastolic BP in children and adolescents from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. The study included 3,929 participants aged 8-19 years who underwent a handgrip test. The sum of the maximum handgrip strength from both hands was used. General linear models were used to examine the associations between handgrip strength and the outcome variables. After adjustment for age, race, sex, body mass index, and physical activities, handgrip strength was significantly and positively associated with systolic (P < 0.0001) and diastolic (P = 0.01) BP. There was an increasing trend in systolic BP as handgrip strength increased from the bottom quartile to the top quartile, with 2.1 mm Hg difference between the top and the bottom quartiles (P for trend <0.0001). Similar results were observed for diastolic BP. Muscular fitness is positively associated with BP in children and adolescents. The implications and underlying mechanisms for these results need further examinations.

Study of blood pressure profile and correlation of hypertension with age, sex, anthropometric measurements (weight, height, body mass index), socio economic status and hereditary factors in school going children

Background: Pre hypertension in childhood is a precursor of hypertension in adulthood. Weight, height and body mass index (BMI) can be taken as surrogate marker of prevalence of hypertension and hence measurement of these parameters can help in early detection of children at risk of hypertension. The present study was done to determine the correlation of hypertension with age, gender, anthropometric measurements, socioeconomic status, and hereditary factors and to estimate the prevalence of hypertension and pre hypertension. Methods: It is an observational study involving 1009 healthy urban school children of 5 to 15 years of age. Height and weight were taken according to standard techniques (Jelliffee 1966). In order to exclude age as a confounding factor; BMI was plotted on percentile charts . Results: There was a linear increase of mean blood pressure with increasing age, height and weight. The mean systolic and diastolic blood pressures of children with BMI 85th to 95th percentile (overweight group) and with BMI ≥95th percentile (obese group) were higher than the lower BMI groups. The children belonging to high socio economic status (class I) and those with family history of hypertension were having higher mean values of systolic and diastolic blood pressure. Equal number of children belonged to pre hypertension (65) and hypertension (67) category. Conclusions: The mean systolic and diagnostic blood pressure was equal in both sexes. Children with overweight/obesity, family history of hypertension and class I socioeconomic status had increased mean values of systolic and diastolic blood pressure. Prevalence of high blood pressure was 13.1% (pre hypertension: 6.44% and hypertension: 6.64%).

Plasma homocysteine and blood pressure in small for gestational age children

Background Homocysteine is associated with endothelial damage and hypertension. Increased plasma homocysteine levels are often accompanied by cardiovascular impairment, including hypertension. Small for gestational age children have been found to have morbidity and mortality in cardiovascular diseases.Objective To assess for a possible association between homocysteine level and blood pressure in small for gestational age children.Methods This observational study was undertaken from December 2011 to April 2012 in Prof. Dr. R. D. Kandou Hospital, Manado, North Sulawesi, on children who were born small for gestational age in year 2004-2005. Data was analyzed by T-test to compare homocysteine levels in small for gestational age and normal birth weight children. Regression analysis and simple coefficient test were used to assess for an association between homocysteine levels and blood pressure in children who were small for gestational age at birth.Results The mean homocysteine level in small for gestational age children was significantly higher than that of normal birth weight children (P&lt;0.001). We observed no correlation between homocysteine level and systolic blood pressure in the small for gestational age group (r=0.151, P=0.189). However, there was a weak correlation between homocysteine level and diastolic blood pressure in the small for gestational age group (r=0.237, P=0.049).Conclusion Children who were small for gestational age at birth have significantly higher mean homocysteine level than that of normal birth weight children. Higher homocysteine levels are associated with higher diastolic blood pressure in children who were small for gestational age at birth.

A multivariate single-index model for longitudinal data

Abstract: Index measures are commonly used in medical research and clinical practice, primarily for quantification of health risks in individual subjects or patients. The utility of an index measure is ultimately contingent on its ability to predict health outcomes. Construction of medical indices has largely been based on heuristic arguments, although the acceptance of a new index typically requires objective validation, preferably with multiple outcomes. In this article, we propose an analytical tool for index development and validation. We use a multivariate single-index model to ascertain the best functional form for risk index construction. Methodologically, the proposed model represents a multivariate extension of the traditional single-index models. Such an extension is important because it assures that the resultant index simultaneously works for multiple outcomes. The model is developed in the general framework of longitudinal data analysis. We use penalized cubic splines to characterize the index components while leaving the other subject characteristics as additive components. The splines are estimated directly by penalizing nonlinear least squares, and we show that the model can be implemented using existing software. To illustrate, we examine the formation of an adiposity index for prediction of systolic and diastolic blood pressure in children. We assess the performance of the method through a simulation study.

Pacific kids DASH for health (PacDASH) randomized, controlled trial with DASH eating plan plus physical activity improves fruit and vegetable intake and diastolic blood pressure in children.

Pacific Kids DASH for Health (PacDASH) aimed to improve child diet and physical activity (PA) level and prevent excess weight gain and elevation in blood pressure (BP) at 9 months. PacDASH was a two-arm, randomized, controlled trial (ClinicalTrials.gov: NCT00905411). Eighty-five 5- to 8-year-olds in the 50th-99th percentile for BMI were randomly assigned to treatment (n=41) or control (n=44) groups; 62 completed the 9-month trial. Sixty-two percent were female. Mean age was 7.1±0.95 years. Race/ethnicity was Asian (44%), Native Hawaiian or Other Pacific Islander (28%), white (21%), or other race/ethnicity (7%). Intervention was provided at baseline and 3, 6 and 9 months, with monthly supportive mailings between intervention visits, and a follow-up visit at 15 months to observe maintenance. Diet and PA were assessed by 2-day log. Body size, composition, and BP were measured. The intervention effect on diet and PA, body size and composition, and BP by the end of the intervention was tested using an F test from a mixed regression model, after adjustment for sex, age, and ethnic group. Fruit and vegetable (FV) intake decreased less in the treatment than control group (p=0.04). Diastolic BP (DBP) was 12 percentile units lower in the treatment than control group after 9 months of intervention (p=0.01). There were no group differences in systolic BP (SBP) or body size/composition. The PacDASH trial enhanced FV intake and DBP, but not SBP or body size/composition.

Associations of eating frequency with adiposity measures, blood lipid profiles and blood pressure in British children and adolescents

Several epidemiological studies in adults have suggested a favourable effect of frequent eating on blood lipid profiles, but evidence in younger populations is lacking. In the present cross-sectional study, we examined the associations of eating frequency (EF) with metabolic risk factors in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Dietary intake was assessed using a 7 d weighed dietary record. EF was calculated based on all eating occasions, except for those providing < 210 kJ of energy. Metabolic risk factors examined were total, HDL-cholesterol and LDL-cholesterol concentrations, TAG concentration, BMI z-score, waist:height ratio (WHtR; only adolescents), and systolic and diastolic blood pressures. Adjustment was made for age, sex, social class, physical activity levels, intakes of protein, fat, total sugar and dietary fibre, ratio of reported energy intake to estimated energy requirement (EI:EER) and BMI z-score (except for BMI z-score and WHtR). In children, EF was inversely associated with total cholesterol and LDL-cholesterol concentrations (n 324, P= 0·01 and 0·04, respectively). Conversely, EF was positively associated with BMI z-score in adolescents (P= 0·004). There were no associations between EF and other metabolic risk factors. In analyses in which only plausible energy reporters (EI:EER: 0·72-1·28) were included, similar results were obtained, except for an inverse association between EF and diastolic blood pressure in children. In conclusion, a higher EF is associated with lower total cholesterol and LDL-cholesterol concentrations in children but with a higher BMI z-score in adolescents.