Indian J Pediatr DOI 10.1007/s12098-014-1573-6
ORIGINAL ARTICLE
The Relationship Between Blood Pressure, Anthropometric Indices and Metabolic Profile in Adolescents: A Cross Sectional Study Setila Dalili & Hamid Mohammadi & Seyed Mahmood Rezvany & Arsalan Dadashi & Mohammad Hassan Novin & Hajar Gholaminejad & Abdolreza Medghalchi & Zahra Mohtasham Amiri & Hossein Dalili & Afagh Hassanzadeh Rad
Received: 9 June 2013 / Accepted: 22 August 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To investigate the relationship between blood pressure, anthropometric indices and metabolic profile in adolescents. Methods The present cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examination including height, weight, blood pressure and body mass index. Also, metabolic profiles including fasting
S. Dalili Department of Pediatric Endocrinology, Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran H. Mohammadi (*) Department of Pediatrics, Shiraz University of Medical Sciences-International Branch, Shiraz, Iran e-mail: [email protected] S. M. Rezvany : A. Dadashi : M. H. Novin : H. Gholaminejad : A. Medghalchi Department of Health Center, Guilan University of Medical Sciences, Guilan, Iran Z. Mohtasham Amiri Department of Social and Preventive Medicine, Guilan University of Medical Sciences, Guilan, Iran H. Dalili Department of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran A. Hassanzadeh Rad Pediatrics Growth Disorders Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
blood sugar (FBS), blood sugar (BS), cholesterol, and triglyceride (TG), low density lipoprotein (LDL), high-density lipoprotein (HDL) and insulin levels were measured. Data were analyzed in SPSS software, by descriptive and analytic statistics and p value 0.05 was considered statistically significant. Results Eight hundred fifty nine adolescents consisting of 550 (64 %) boys and 309 (34 %) girls participated in this study; 11.4 % (84/739 cases) of the participants had hypertension. The strongest correlation was seen between systolic blood pressure and weight, waist or hip circumferences and insulin levels. Also, FBS had very weak correlation with blood pressure. Conclusions Thus, weight, waist and hip circumferences, insulin levels, high TG and low HDL have been indicated as the strongest correlating factors for high blood pressure.Thus, these factors should be investigated in high risk children and followed in hypertensive child to monitor cardiometabolic risk factors. Keywords Blood pressure . Anthropometry . Lipoproteins . Adolescent
Introduction Hypertension (HTN) is a global health problem, and it is welldocumented that increased blood pressure (BP) becomes established in childhood [1]. A growing evidence indicate that not only HTN gradually damages the function of vital organs, but also pre-HTN has the same harmful effects [2]. Although, the prevalence of hypertension among adolescents is approximately 3.5 % [3] approximately 54 % of stroke and 47 % of ischemic heart disease which occurs, worldwide are attributable to high blood pressure [4].
Indian J Pediatr
According to previous investigations, factors such as methodological differences in measurement, socio demographic factors, adiposity levels and ethnicity appear to influence the distribution of blood pressure as well as prevalence of hypertension. The prevalence and severity of overweight status is clearly increasing [5] and this increase has also indicated an increase in the prevalence of type 2 diabetes mellitus and premature onset of cardiovascular risk factors such as hypertension [6, 7]. The pathophysiology of obesity-related hypertension is complex, and multiple potential mechanisms contribute to the development of higher blood pressure in obese children. These include hyperinsulinemia, activation of the reninangiotensin-aldosterone system, stimulation of the sympathetic nervous system, abnormalities in adipokines such as leptin, direct effects of perinephric fat on the renal parenchyma, and cytokines acting at the vascular endothelial level [8]. The link between obesity and hypertension which may be mediated in part by sympathetic nervous system (SNS) hyperactivity, includes cardiovascular manifestations such as increased heart rate and blood pressure variability, neurohumoral manifestations such as increased levels of plasma catecholamine, and neural manifestations such as increased peripheral sympathetic nerve traffic [9]. Consistent with the SNS hyperactivity hypothesis, high blood pressure in children and adolescents is a growing health problem that is often overlooked by physicians [10]. Since early interventions to reduce childhood obesity can reduce prolonged BP elevation and the future risk of cardiovascular disease and other complications [11–13], this article aimed to investigate the relationship between blood pressure with anthropometric indices and metabolic profile in adolescents.
Material and Methods The present descriptive cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. All of these cases were examined by a trained physician and data were recorded. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examinations including height, weight, blood pressure and body mass index. For each patient with high blood pressure in the first visit, two additional visits were scheduled and mean blood pressure was recorded. Blood pressure stages were indicated as normal (a systolic and/or diastolic BP
ORIGINAL ARTICLE
The Relationship Between Blood Pressure, Anthropometric Indices and Metabolic Profile in Adolescents: A Cross Sectional Study Setila Dalili & Hamid Mohammadi & Seyed Mahmood Rezvany & Arsalan Dadashi & Mohammad Hassan Novin & Hajar Gholaminejad & Abdolreza Medghalchi & Zahra Mohtasham Amiri & Hossein Dalili & Afagh Hassanzadeh Rad
Received: 9 June 2013 / Accepted: 22 August 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objective To investigate the relationship between blood pressure, anthropometric indices and metabolic profile in adolescents. Methods The present cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examination including height, weight, blood pressure and body mass index. Also, metabolic profiles including fasting
S. Dalili Department of Pediatric Endocrinology, Pediatric Growth Disorders Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran H. Mohammadi (*) Department of Pediatrics, Shiraz University of Medical Sciences-International Branch, Shiraz, Iran e-mail: [email protected] S. M. Rezvany : A. Dadashi : M. H. Novin : H. Gholaminejad : A. Medghalchi Department of Health Center, Guilan University of Medical Sciences, Guilan, Iran Z. Mohtasham Amiri Department of Social and Preventive Medicine, Guilan University of Medical Sciences, Guilan, Iran H. Dalili Department of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran A. Hassanzadeh Rad Pediatrics Growth Disorders Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
blood sugar (FBS), blood sugar (BS), cholesterol, and triglyceride (TG), low density lipoprotein (LDL), high-density lipoprotein (HDL) and insulin levels were measured. Data were analyzed in SPSS software, by descriptive and analytic statistics and p value 0.05 was considered statistically significant. Results Eight hundred fifty nine adolescents consisting of 550 (64 %) boys and 309 (34 %) girls participated in this study; 11.4 % (84/739 cases) of the participants had hypertension. The strongest correlation was seen between systolic blood pressure and weight, waist or hip circumferences and insulin levels. Also, FBS had very weak correlation with blood pressure. Conclusions Thus, weight, waist and hip circumferences, insulin levels, high TG and low HDL have been indicated as the strongest correlating factors for high blood pressure.Thus, these factors should be investigated in high risk children and followed in hypertensive child to monitor cardiometabolic risk factors. Keywords Blood pressure . Anthropometry . Lipoproteins . Adolescent
Introduction Hypertension (HTN) is a global health problem, and it is welldocumented that increased blood pressure (BP) becomes established in childhood [1]. A growing evidence indicate that not only HTN gradually damages the function of vital organs, but also pre-HTN has the same harmful effects [2]. Although, the prevalence of hypertension among adolescents is approximately 3.5 % [3] approximately 54 % of stroke and 47 % of ischemic heart disease which occurs, worldwide are attributable to high blood pressure [4].
Indian J Pediatr
According to previous investigations, factors such as methodological differences in measurement, socio demographic factors, adiposity levels and ethnicity appear to influence the distribution of blood pressure as well as prevalence of hypertension. The prevalence and severity of overweight status is clearly increasing [5] and this increase has also indicated an increase in the prevalence of type 2 diabetes mellitus and premature onset of cardiovascular risk factors such as hypertension [6, 7]. The pathophysiology of obesity-related hypertension is complex, and multiple potential mechanisms contribute to the development of higher blood pressure in obese children. These include hyperinsulinemia, activation of the reninangiotensin-aldosterone system, stimulation of the sympathetic nervous system, abnormalities in adipokines such as leptin, direct effects of perinephric fat on the renal parenchyma, and cytokines acting at the vascular endothelial level [8]. The link between obesity and hypertension which may be mediated in part by sympathetic nervous system (SNS) hyperactivity, includes cardiovascular manifestations such as increased heart rate and blood pressure variability, neurohumoral manifestations such as increased levels of plasma catecholamine, and neural manifestations such as increased peripheral sympathetic nerve traffic [9]. Consistent with the SNS hyperactivity hypothesis, high blood pressure in children and adolescents is a growing health problem that is often overlooked by physicians [10]. Since early interventions to reduce childhood obesity can reduce prolonged BP elevation and the future risk of cardiovascular disease and other complications [11–13], this article aimed to investigate the relationship between blood pressure with anthropometric indices and metabolic profile in adolescents.
Material and Methods The present descriptive cross sectional study was conducted in 1005, 12-y-old junior students referred to 15 urban health centers of Rasht. All of these cases were examined by a trained physician and data were recorded. Samples were recruited randomly and data were collected in a form which consisted of demographic characteristics, history of disease in samples and their immediate families, birth weight, physical examination and clinical examinations including height, weight, blood pressure and body mass index. For each patient with high blood pressure in the first visit, two additional visits were scheduled and mean blood pressure was recorded. Blood pressure stages were indicated as normal (a systolic and/or diastolic BP
