Systolic Blood Pressure In Children Research Articles

Increased Resting and Peak Exercise Systolic Blood Pressure in Children Throughout the COVID-19 Pandemic.

The COVID-19 pandemic created significant disruptions to daily life. Lockdown effects resulted in decreased exercise capacity and increased blood pressure in adults and adolescents in the first year of the pandemic. We examined changes in exercise capacity (peak workload, ventilatory anaerobic threshold-VAT, and VO2 peak), resting BP, and peak exercise BP in children before the COVID-19 pandemic and throughout five 6-month intervals of the pandemic. 951 maximal cardiopulmonary exercise tests completed by healthy children aged ≤ 18years were analyzed retrospectively. BP was auscultated. Tests were divided into pre-pandemic and six-month intervals starting from the declaration of the pandemic (Interval 1: March 11 2020-August 2020, Interval 2: September 2020-February 2021, Interval 3: March-August 2021, Interval 4: September 2021-February 2022, Interval 5: March-August 2022). Peak workload, VAT, and VO2 peak were unchanged from pre-pandemic baseline until Interval 3, when they were significantly decreased. Exercise capacity then returned to values unchanged from baseline. Peak exercise systolic BP was significantly higher than baseline in Intervals 2, 4, and 5. Resting systolic BP was significantly higher than baseline in Interval 5. There was no significant difference in age, sex, BMI, or peak exercise heart rate between intervals. Peak exercise BP was elevated above pre-pandemic baseline when exercise capacity was unchanged. The decrease in exercise capacity subsequently resolved, but the increase in post-exercise BP remained in Intervals 4 and 5. An increase in peak exercise BP preceded a small but significant increase in resting systolic BP.

Prenatal Urban Environment and Blood Pressure Trajectories From Childhood to Early Adulthood

BackgroundPrenatal urban environmental exposures have been associated with blood pressure in children. The dynamic of these associations across childhood and later ages is unknown. ObjectivesThe purpose of this study was to assess associations of prenatal urban environmental exposures with blood pressure trajectories from childhood to early adulthood. MethodsRepeated measures of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were collected in up to 7,454 participants from a UK birth cohort. Prenatal urban exposures (n = 43) covered measures of noise, air pollution, built environment, natural spaces, traffic, meteorology, and food environment. An exposome-wide association study approach was used. Linear spline mixed-effects models were used to model associations of each exposure with trajectories of blood pressure. Replication was sought in 4 independent European cohorts (up to 9,261). ResultsIn discovery analyses, higher humidity was associated with a faster increase (mean yearly change in SBP for an interquartile range increase in humidity: 0.29 mm Hg/y, 95% CI: 0.20-0.39) and higher temperature with a slower increase (mean yearly change in SBP per interquartile range increase in temperature: −0.17 mm Hg/y, 95% CI: −0.28 to −0.07) in SBP in childhood. Higher levels of humidity and air pollution were associated with faster increase in DBP in childhood and slower increase in adolescence. There was little evidence of an association of other exposures with change in SBP or DBP. Results for humidity and temperature, but not for air pollution, were replicated in other cohorts. ConclusionsReplicated findings suggest that higher prenatal humidity and temperature could modulate blood pressure changes across childhood.

Potentials of Hyperuricemia and Insulin Levels in Predicting Hypertension in Obese Children: A Cross-Sectional Study

Background: Recent studies in humans show that increased uric acid predicts hyperinsulinemia and obesity. Objectives: Our study aimed to investigate whether hyperuricemia and insulin levels predict hypertension in obese children. Methods: This analytical cross-sectional study was conducted on the records of 161 obese children aged 5 to 15 years old based on the defined inclusion criteria. Children's blood pressure, height, weight, FBS (fasting blood sugar), HDL (high-density lipoprotein), LDL (low-density lipoprotein), TG (triglyceride), HbA1c (hemoglobin A1c), urine albumin, creatinine, insulin levels, and uric acid were measured. Data were analyzed by SPSS software. The significance level was considered P < 0.05. Results: According to the data obtained from this study, the mean of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in obese children with hyperuricemia was higher than in obese children without hyperuricemia. The average insulin in obese children and hypertension was higher than in obese children without hypertension, especially in males and the age group of 5 - 10 years. The levels of cholesterol and LDL in hypertensive males were higher than in those with hyperuricemia. HDL was higher in children without hyperuricemia than in children with hyperuricemia. The strongest predictors of uric acid were age (P < 0.001, B = 0.183), HbA1c (P = 0.014, B = 0.255), and cholesterol (P = 0.03, B = -0.007), respectively. Conclusions: Based on this study, there is a relationship between uric acid levels and parameters such as obesity and blood pressure, and the findings showed that increased uric acid predicts hyperinsulinemia and obesity. Therefore, this study indicates that physicians and healthcare workers should consider the level and state of uric acid.

Pre-hypertension genes in the avon longitudinal study of parents and children (ALSPAC) predict higher systolic blood pressure in children from the manchester babyGRO study

Pre-hypertension genes in the avon longitudinal study of parents and children (ALSPAC) predict higher systolic blood pressure in children from the manchester babyGRO study

Fat-free mass may play a dominant role in the association between systolic blood pressure and body composition in children and adolescents.

Systolic blood pressure (SBP) is significantly associated with body composition in children and adolescents. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We, therefore, aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey with cross-sectional analysis. In total, 13618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Multiple linear regression showed that SBP was associated with higher total fat-free mass in boys (β = 0·49, P < 0·001) and girls (β = 0·47, P < 0·001) and with higher total fat mass only in boys (β = 0·12, P < 0·001) after adjustment for covariates. When taking fat distribution into consideration, SBP was associated with higher trunk fat mass (boys: β = 0·28, P < 0·001; girls: β = 0·15, P < 0·001) but negatively associated with leg fat mass (Boys: β = -0·14, P < 0·001; Girls: β = -0·11, P < 0·001), in both boys and girls. Dominance analysis showed that total fat-free mass was the dominant contributor to SBP (boys: 49 %; girls: 55·3 %), followed by trunk fat mass (boys: 32·1 %; girls: 26·9 %); leg fat mass contributed the least to SBP in boys (18·9 %) and girls (17·8 %). Our findings indicated that total fat-free mass was not only associated with SBP but also the most dominant contributor to SBP variation in American children and adolescents.

Blood pressure, arterial stiffness, and cardiovascular risk profiles in 8-12-year-old children following preeclampsia (FINNCARE-study).

The aim was to study if children following preeclampsia (PE) develop alterations in blood pressure (BP) and arterial stiffness already early in life, and how this is associated with gestational, perinatal and child cardiovascular risk profiles. One hundred eighty-two PE (46 early-onset with diagnosis before 34 gestational weeks, and 136 late-onset) and 85 non-PE children were assessed 8-12 years from delivery. Office and 24-h ambulatory BP, body composition, anthropometrics, lipids, glucose, inflammatory markers, and tonometry-derived pulse wave velocity (PWV) and central BPs were assessed. Office BP, central BPs, 24-h systolic BP (SBP) and pulse pressure (PP) were higher in PE compared with non-PE. Early-onset PE children had the highest SBP, SBP-loads, and PP. SBP nondipping during night-time was common among PE. The higher child 24-h mean SBP among PE was explained by maternal SBP at first antenatal visit and prematurity (birth weight or gestational weeks), but child 24-h mean PP remained related with PE and child adiposity after adjustments. Central and peripheral PWVs were elevated in late-onset PE subgroup only and attributed to child age and anthropometrics, child and maternal office SBP at follow-up, but relations with maternal antenatal SBPs and prematurity were not found. There were no differences in body anthropometrics, composition, or blood parameters. PE children develop an adverse BP profile and arterial stiffness early in life. PE-related BP is related with maternal gestational BP and prematurity, whereas arterial stiffness is determined by child characteristics at follow-up. The alterations in BP are pronounced in early-onset PE.Clinical Trial Registration information: https://clinicaltrials.gov/ct2/show/NCT04676295ClinicalTrials.gov Identifier: NCT04676295.

FAT-FREE MASS DOMINATES THE RELATIONSHIP BETWEEN BODY COMPOSITION AND SYSTOLIC BLOOD PRESSURE IN CHILDREN AND ADOLESCENTS

Objective: Systolic blood pressure (SBP) significantly associates with body composition. However, which one of the components of body composition is the dominant contributor to SBP in children and adolescents remains unclear. We aimed to determine the dominant contributor to SBP among components of body composition in a large cohort of American children and adolescents derived from the National Health and Nutrition Examination Survey. Design and method: 13618 children and adolescents (median age 13 years; 6107 girls) with available data on whole-body dual-emission X-ray absorptiometry measurements were included. Results: Multiple linear regression showed that SBP significantly associated with fat-free mass in boys (↓ = 0.49, P&lt;0.001) and girls (↓ = 0.47, P&lt;0.001) and with total fat mass only in boys (↓ = 0.12, P&lt;0.001), after adjustment for covariates. When taking fat distribution into consideration, SBP positively associated with trunk fat mass (Boys: ↓ = 0.28, P&lt;0.001; Girls: ↓ = 0.15, P&lt;0.001), but negatively associated with leg fat mass (Boys: ↓ = -0.14, P&lt;0.001; Girls: ↓ = -0.11, P&lt;0.001), in both boys and girls. Dominance analysis showed that fat-free mass was the dominant contributor to SBP (boys: 49%; girls: 55.3%), followed by trunk fat mass (boys: 32.1%; girls: 26.9%); leg fat mass contributed the least to SBP in boys (18.9%) and girls (17.8%). Conclusions: Fat-free mass was not only significantly associated with SBP, but also the most dominant contributor to SBP variation in American children and adolescents.

A genome-wide association study of childhood adiposity and blood lipids

Background: The rising prevalence of childhood obesity and dyslipidaemia is a major public health concern due to its association with morbidity and mortality in later life. Previous studies have found that genetic variants inherited at birth can begin to exert their effects on cardiometabolic traits during the early stages of the lifecourse. Methods: In this study, we have conducted genome-wide association studies (GWAS) for eight measures of adiposity and lipids in a cohort of young individuals (mean age 9.9 years, sample sizes=4,202 to 5,766) from the Avon Longitudinal Study of Parents and Children (ALSPAC). These measures were body mass index (BMI), systolic and diastolic blood pressure, high- density and low-density lipoprotein cholesterol, triglycerides, apolipoprotein A-I and apolipoprotein B. We next undertook functional enrichment, pathway analyses and linkage disequilibrium (LD) score regression to evaluate genetic correlations with later-life cardiometabolic diseases. Results: Using GWAS we identified 14 unique loci associated with at least one risk factor in this cohort of age 10 individuals (P&lt;5x10-8), with lipoprotein lipid-associated loci being enriched for liver tissue-derived gene expression and lipid synthesis pathways. LD score regression provided evidence of various genetic correlations, such as childhood systolic blood pressure being genetically correlated with later-life coronary artery disease (rG=0.26, 95% CI=0.07 to 0.46, P=0.009) and hypertension (rG=0.37, 95% CI=0.19 to 0.55, P=6.57x10-5), as well as childhood BMI with type 2 diabetes (rG=0.35, 95% CI=0.18 to 0.51, P=3.28x10-5). Conclusions: Our findings suggest that there are genetic variants inherited at birth which begin to exert their effects on cardiometabolic risk factors as early as age 10 in the life course. However, further research is required to assess whether the genetic correlations we have identified are due to direct or indirect effects of childhood adiposity and lipid traits.

Maternal smoking in pregnancy and blood pressure during childhood and adolescence: a meta-analysis

Arterial hypertension during childhood or adolescence is rising, and smoking during pregnancy may constitute a modifiable risk factor. This study aims to evaluate the effect of maternal smoking during pregnancy on diastolic (DBP) and systolic blood pressure (SBP) in childhood and adolescence. A bibliographic search was conducted in PubMed, Embase, and CENTRAL databases in March 2022. Meta-analysis was performed with the difference in mean-adjusted SBP/DBP of children and adolescents aged 3–17 years, according to maternal smoking/non-smoking in pregnancy. A random effects model was applied; a leave-one-out analysis and meta-analysis by subgroups were performed. A modified Newcastle–Ottawa scale was used to assess the quality of the studies. Evidence levels were rated using the GRADE system. Fifteen studies were included in the meta-analysis; all of them evaluated the mean-adjusted SBP difference in children or adolescents (N = 73,448), and 6 also that of DBP (N = 31,459). Results showed that maternal smoking during pregnancy significantly increased SBP (β = 0.31 mmHg 95% CI 0.14–0.49). A greater increase in mean-adjusted SBP was observed in those studies that completed the recruitment before 1990, were conducted in non-European countries, used standard mercury or manual sphygmomanometry, adjusted for birth weight, and were in the lowest quality subgroup. No significant association was found for DBP. The GRADE level of evidence was low for SBP and very low for DBP.Conclusion: Smoking in pregnancy might increase SBP in childhood and adolescence. Due to the low level of evidence, solid inferences cannot be drawn about the clinical relevance of these findings. What is Known:• AHT is the leading cause of premature death among adults worldwide.• Deleterious effects derived from SHS exposure on children's health have been documented since early 1970. To date, there are contradictory results about the effects of prenatal SHS exposure on children’s BP.What is New:• Smoking in pregnancy may increase SBP during childhood and adolescence.• Maternal smoking during pregnancy could have greater influence on their offspring's SBP than on DBP.

Genetic Variants Associated With Systolic Blood Pressure in Children and Adolescents.

Background Genetics, along with lifestyle and behavioral characteristics, play an important role in hypertension in adults. Our aim was to identify genetic variants associated with blood pressure in childhood and adolescence. Methods and Results We conducted a candidate single-nucleotide polymorphism (SNP) analysis and genome-wide association study among 9778 participants aged <18 years in BioVU, the Vanderbilt University Medical Center biobank. The outcome was childhood blood pressure percentile from age 0 to 18 years. For the candidate SNP analysis, a total of 457 previously identified SNPs were examined. Linear regression was used to test the association between genetic variants and median systolic blood pressure (SBP) percentile. Adjusted models included median age, self-reported sex, race, the first 4 principal components of ancestry, and median body mass index Z score. Analyses were conducted in the overall cohort and stratified by age group. A polygenic risk score was calculated for each participant, and the association between polygenic risk score and median SBP percentile in childhood was examined using linear regression. In the overall candidate SNP analysis, 2 SNPs reached significance: rs1018148 (FBN1; P=1.0×10-4) and rs11105354 (ATP2B1; P=1.4×10-4). In the postpuberty age group, 1 SNP reached significance: rs1018148 (FBN1; P=2.2×10-5). In the genome-wide association study of all participants, no SNPs reached genome-wide significance. Higher polygenic risk score was associated with higher SBP percentile (β, 0.35 [95% CI, 0.10-0.60)], and there was a significant interaction with age (P for interaction<0.01). Conclusions These findings suggest that genetic variants play an important role in SBP in childhood and adolescence and provide evidence for age-specific genetic associations with SBP.

PS-P04-4: BLOOD PRESSURE VARIABILITY IN PRESCHOOL CHILDREN

Objective: To investigate the blood pressure variability (BPV) and its relevant factors in preschool children. Design and method: A total of 497 preschool children from two public kindergartens in Shanghai were enrolled. Blood pressure (BP) was standardized measured three times consecutively in a sitting position. Demographic information was collected. The measures used for BPV were the difference between the third and the first systolic blood pressure (SBP) (Delta-SBP), the difference between the third and the first diastolic blood pressure (DBP) (Delta-DBP), standard deviation of SBP (SBPSD) and DBP (DBPSD), and coefficient of variation of SBP (SBPCV) and DBP (DBPCV). Statistical analysis was performed by SAS9.4. Results: The subjects were on average 4.5 ± 0.8 years and 49.7% male. Mean blood pressure was 96/56mmHg. BPV was not significantly different between sex, however, it was significantly different among different SBP grade groups. According to the quartile of the first SBP, the subjects were divided into four groups. SBPSD and SBPCV were greater with the increase in SBP level. DBPSD and DBPCV were not significantly different among groups. Multiple linear regression showed that Delta-SBP was negatively correlated with the first SBP (Fig. 1), that was, the higher the first SBP, the magnitude of decrease from the third SBP to the first SBP was greater. After adjustment for sex, age, height, and weight, the first SBP was positively correlated with SBPCV. Conclusions: This study revealed that the higher the first SBP in preschool children, the greater the blood pressure variability may be.

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.

The roles of newborn anthropometrics in the association between maternal weight gain and childhood cardiovascular risks.

The aim was to study the association between newborn anthropometrics and childhood cardiovascular risks and whether newborn anthropometrics mediate the effect of maternal gestational weight gain (GWG) on childhood risks. Data of 926 mother-child dyads from the Hyperglycemia and Adverse Pregnancy Outcomes study were analyzed. Newborn anthropometrics were treated as predictors and mediators by using a regression model and causal mediation model, respectively. Newborn sum of skinfolds (SSF) was associated with childhood diastolic blood pressure (DBP) and pulse wave velocity (coefficients [95% CI]: 0.13 [0.06 to 0.20]; 0.08 [0.004 to 0.15]), whereas newborn ponderal index (PI) was inversely associated with childhood systolic blood pressure (SBP), DBP, and pulse wave velocity (-0.08 [-0.15 to -0.01]; -0.08 [-0.14 to -0.008]; -0.09 [-0.16 to -0.03]). Newborn SSF mediated the effects of maternal excessive GWG on childhood SSF and DBP (proportion of total effect 9% and 8%, respectively). In contrast, a significant negative mediation through newborn PI was found for the effect of maternal excessive GWG on childhood DBP (-8%) and its effect on childhood SBP through birth weight (-27%). Childhood cardiovascular risks are positively associated with newborn SSF but inversely associated with newborn PI. Newborn SSF mediates the impact of excessive maternal GWG on childhood BP, but birth weight and newborn PI negatively mediate it.

The Arginine-nitric-oxide pathway links suboptimal fetal growth to higher childhood systolic blood pressure in the manchester babyGRO study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Maternal calcium intake during pregnancy and childhood blood pressure: the Kyushu Okinawa Maternal and Child Health Study

Evidence regarding the relationship between maternal calcium intake during pregnancy and childhood blood pressure is limited and inconsistent. The present prebirth cohort study examined this issue in Japanese children aged 6 years. Subjects were 854 mother-child pairs. Maternal intake during pregnancy was assessed with a validated diet history questionnaire. A research technician measured systolic and diastolic blood pressures at home in children aged 6 years using an electronic sphygmomanometer. Analysis of covariance was used to calculate adjusted means of systolic and diastolic blood pressures according to maternal calcium intake during pregnancy. Maternal calcium intake during pregnancy was not related to systolic blood pressure in children. On the other hand, compared with children of mothers whose calcium intake during pregnancy was in the lowest quartile, those of mothers whose calcium intake during pregnancy was in the highest quartile had 2.8 mmHg lower adjusted mean diastolic blood pressure (95% confidence interval: 0.3-5.3 mmHg, P for trend=.009). Higher maternal calcium intake during pregnancy may be associated with a decrease in diastolic, but not systolic, blood pressure in Japanese children aged 6 years.

Evaluation of pulse wave velocity and central systolic blood pressure in children and adolescents with chronic kidney disease

ABSTRACTObjective Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease.Methods In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles.Results The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02).Conclusion Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Energy Drinks: Effects on Blood Pressure and Heart Rate in Children and Teenagers. A Randomized Trial.

BackgroundThe consumption of Energy Drinks (ED) is very popular among children and teenagers. While potential cardiovascular side effects of these beverages are suggested, the acute impact of ED consumption on the pediatric cardiovascular system has not been systematically examined yet. The aim of this study was to investigate the acute effects of ED consumption on blood pressure and heart rate in healthy children and teenagers.MethodsThis study was a randomized, single-blind, placebo-controlled, crossover clinical trial. On two consecutive days, the study participants were asked to consume a weight-adjusted amount of an ED (3 mg caffeine per kg of body weight) or a placebo containing a similar amount of sugar but without conventional ED ingredients. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were measured at the following time points: baseline as well as 30, 60, 120 and 240 min after beverage consumption.ResultsIn total, 27 healthy children and adolescents (mean age 14.53 ± 2.40 years, 14 male) were included in the present study. Compared to placebo intake, mean SBP was demonstrated to be up to 5.23 mmHg (p < 0.0001) and mean DBP up to 3.29 mmHg (p < 0.001) increased after ED consumption. Prevalence of elevated blood pressure, stage 1 and stage 2 hypertension was higher after ED consumption. Heart rate tended to be lower after ED consumption.ConclusionsThe acute ED consumption is associated with a significantly increased SBP and DBP in healthy children and teenagers. Minors, particularly those with pre-existing health conditions, should be discouraged from drinking EDs.Clinical Trial Registrationhttps://www.drks.de/drks_web/, identifier: DRKS00027580.

Abstract P034: The Association Of Breastfeeding With Lower Blood Pressure Is Stronger In Children Born Vaginally Compared To Cesarean Section

Introduction: A recent study of mother-child pairs in Canada (Miliku et al., JAHA 2021) found that ever (vs. never) breastfeeding was associated with lower blood pressure (BP) in early childhood. The authors posited the effect is modulated by the microbiome. However, they did not examine if the breastfeeding effect is stronger in vaginally-delivered infants, whom host more bacterial species (e.g., Bifidobacteria ) that bioconvert human milk oligosaccharides into BP-lowering butyrate. Given their population was majority White, it is unknown if breastfeeding lowers BP in non-White populations. Hypothesis: Introduction to breast milk in infancy lowers BP in childhood, particularly among vaginally delivered infants, in a racially diverse population. Methods: We used data from the Boston Birth Cohort. We assessed breastfeeding status during the postnatal follow up at &lt;2 years of age. Ever breastfeeding was defined as exclusively breastfed or a mix of breastfed and bottle-fed. We obtained repeated clinical measures of childhood systolic BP (SBP) across 0-17 years of age. We calculated age-, sex-, and height- specific child BP percentiles according to the 2017 American Academy of Pediatrics Clinical Practice Guidelines. We used linear regression with GEE with a link function and AR-1 correlation to examine the association of ever breastfeeding with child SBP. We controlled for maternal age, education, smoking, parity, pre-pregnancy BMI, hypertension, and child low birthweight, preterm birth, age, and sex. We assessed effect modification by race and delivery mode. Results: Our analytic sample comprised 19,597 BP measurements from 2,077 children, who were 52% male, 66% black, and had a mean age of 8 years. Among our sample, 33% were born preterm, 59% were vaginally delivered, and 74% were ever breastfed. Ever (vs. never) breastfeeding was associated with 1.74 percentile (95% CI: -3.66, 0.19; p=0.08) lower SBP. In children who were delivered vaginally, ever breastfeeding was associated with 2.63 percentile (95% CI: -5.12, -0.14; p=0.04) lower SBP. In contrast, among children delivered by Cesarean section, SBP percentile was not significantly reduced (95% CI: -3.45, 2.59; p=0.78) among ever breastfed. Moreover, ever breastfeeding was more strongly associated with lower BP among participants who self-identified as non-Black (3.40 percentile lower SBP; 95% CI: -6.30, -0.49; p=0.02) vs. Black (0.98 percentile lower SBP; 95% CI: -3.42, 1.45; p=0.43). Conclusion: In our racially diverse cohort, ever vs. never breastfeeding was associated with lower BP among children who were delivered vaginally, but not among those delivered by Cesarean section. The protective association of ever breastfeeding on child BP was also weaker in those born to mothers who self-identified as Black, highlighting the need for more research on the effects of breastfeeding on cardiometabolic health in racial minority groups.

The association between fluoride in water and blood pressure in children and adolescents.

The objective of this study was to determine the association between water and plasma fluoride and blood pressure (BP) among children and adolescents. Our study population was individuals of 8-18 years in the 2013-2016 National Health and Nutrition Examination Survey. We performed a multivariable linear and logistic regression analysis to examine the relationship between fluoride and BP. In a linear regression analysis for systolic BP (SBP) (mmHg) adjusting for age, sex, race, and poverty, fluoride in water (mg/L) was significant with a coefficient of -0.44 (p = 0.046) among adolescents (12-18 years). Additional adjustments for race, poverty, serum levels of cotinine, and BMI remained significant. While an inverse relationship was found in children (8-11 years), none were significant. Fluoride in plasma was not significant across all ages. The odds ratio of high BP for an increase in water fluoride also was not significant. Higher concentrations of fluoride in water were associated with low SBP only among adolescents. Fluoride alone cannot be responsible for BP as several biological metabolic processes may influence its physiological effects. Fluoride consumption should be considered in conjunction with these processes. The high fluoride in drinking water was statistically significantly associated with low systolic BP in children and adolescents. The odds ratio of high BP for an increase in fluoride in drinking water was not significant. Our study contributes to the existing literature by providing individualized data and results on an individual level.

Rapid Growth in Malnutrition Children Associated with Higher Systolic Blood Pressure in Adolescent

BACKGROUND: Several studies found that children experiencing rapid growth earlier in life might increase the risk of chronic disease. Cardiovascular disease and hypertension are common risk factors and have been the leading cause of death worldwide. However, studies investigating the effects of rapid growth in early life on blood pressure later in life are limited. AIM: This study aimed to analyze the association between rapid growth after the first 1000 days of life and blood pressure at 17−19 years old. METHODS: We analyzed 17-year follow-up cohort using secondary data from the Indonesian Family Life Survey from the second (1997), third (2000), and fifth wave (2014). The survey was conducted in 13 provinces in Indonesia. No more than 672 children under 2 years old were included in the study. Rapid growth was defined as an alteration in length or height-per-age and weight-per-age z-score, based on WHO Child Growth Standard, on 1997 and 2000 time frame which was greater than 0.67, experienced by children with malnutrition (low birth weight, stunted, underweight, and wasting). Blood pressure was measured three times by an oscillometric method in 2014. In addition, we used a one-way ANOVA (analysis of variance) test to assess the association of rapid growth on systolic blood pressure. RESULTS: Malnutrition children at 0-2-year-old that grow rapidly in length or height, had higher systolic blood pressure than normal children (p = 0.029). In contrast, there was no difference observed in systolic blood pressure in children with malnutrition and children who did not experience rapid growth in weight. CONCLUSIONS: Children who had a history of malnutrition earlier in life (0−23 months) and had rapid growth in length or height after the first 1000 days of life had higher systolic blood pressure than normal children and children with malnutrition who did not grow rapidly.