Dataset Information

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

ABSTRACT: Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (China, India, Iran, Korea, Poland, Tunisia, and the United States).Data on BP for 52 636 nonoverweight children and adolescents aged 6 to 19 years were obtained from 7 large nationally representative cross-sectional surveys in China, India, Iran, Korea, Poland, Tunisia, and the United States. BP values were obtained with certified mercury sphygmomanometers in all 7 countries by using standard procedures for BP measurement. Smoothed BP percentiles (50th, 90th, 95th, and 99th) by age and height were estimated by using the Generalized Additive Model for Location Scale and Shape model. BP values were similar between males and females until the age of 13 years and were higher in males than females thereafter. In comparison with the BP levels of the 90th and 95th percentiles of the US Fourth Report at median height, systolic BP of the corresponding percentiles of these international references was lower, whereas diastolic BP was similar.These international BP references will be a useful tool for international comparison of the prevalence of elevated BP in children and adolescents and may help to identify hypertensive youths in diverse populations.

SUBMITTER: Xi B

PROVIDER: S-EPMC4729639 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

Xi Bo B Zong Xin'nan X Kelishadi Roya R Hong Young Mi YM Khadilkar Anuradha A Steffen Lyn M LM Nawarycz Tadeusz T Krzywińska-Wiewiorowska Małgorzata M Aounallah-Skhiri Hajer H Bovet Pascal P Chiolero Arnaud A Pan Haiyan H Litwin Mieczysław M Poh Bee Koon BK Sung Rita Y T RY So Hung-Kwan HK Schwandt Peter P Haas Gerda-Maria GM Neuhauser Hannelore K HK Marinov Lachezar L Galcheva Sonya V SV Motlagh Mohammad Esmaeil ME Kim Hae Soon HS Khadilkar Vaman V Krzyżaniak Alicja A Romdhane Habiba Ben HB Heshmat Ramin R Chiplonkar Shashi S Stawińska-Witoszyńska Barbara B El Ati Jalila J Qorbani Mostafa M Kajale Neha N Traissac Pierre P Ostrowska-Nawarycz Lidia L Ardalan Gelayol G Parthasarathy Lavanya L Zhao Min M Zhang Tao T

Circulation 20151215 4

<h4>Background</h4>Several distributions of country-specific blood pressure (BP) percentiles by sex, age, and height for children and adolescents have been established worldwide. However, there are no globally unified BP references for defining elevated BP in children and adolescents, which limits international comparisons of the prevalence of pediatric elevated BP. We aimed to establish international BP references for children and adolescents by using 7 nationally representative data sets (Chin ...[more]

PMID: 26671979

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Project description:BackgroundWaist-to-height ratio (WHtR) has been proposed as a simple and effective screening tool for assessing central obesity and cardiometabolic risk in both adult and pediatric populations. However, evidence suggests that the use of a uniform WHtR cut-off of 0.50 may not be universally optimal for pediatric populations globally. We aimed to determine the optimal cut-offs of WHtR in children and adolescents with increased cardiometabolic risk across different countries worldwide.MethodsWe used ten population-based cross-sectional data on 24,605 children and adolescents aged 6-18 years from Brazil, China, Greece, Iran, Italy, Korea, South Africa, Spain, the UK, and the USA for establishing optimal WHtR cut-offs. We performed an external independent test (9,619 children and adolescents aged 6-18 years who came from other six countries) to validate the optimal WHtR cut-offs based on the predicting performance for at least two or three cardiometabolic risk factors.ResultsBased on receiver operator characteristic curve analyses of various WHtR cut-offs to discriminate those with ≥ 2 cardiometabolic risk factors, the relatively optimal percentile cut-offs of WHtR in the normal weight subsample population in each country did not always coincide with a single fixed percentile, but varied from the 75th to 95th percentiles across the ten countries. However, these relatively optimal percentile values tended to cluster irrespective of sex, metabolic syndrome (MetS) criteria used, and WC measurement position. In general, using ≥ 2 cardiometabolic risk factors as the predictive outcome, the relatively optimal WHtR cut-off was around 0.50 in European and the US youths but was lower, around 0.46, in Asian, African, and South American youths. Secondary analyses that directly tested WHtR values ranging from 0.42 to 0.56 at 0.01 increments largely confirmed the results of the main analyses. In addition, the proposed cut-offs of 0.50 and 0.46 for two specific pediatric populations, respectively, showed a good performance in predicting ≥ 2 or ≥ 3 cardiometabolic risk factors in external independent test populations from six countries (Brazil, China, Germany, Italy, Korea, and the USA).ConclusionsThe proposed international WHtR cut-offs are easy and useful to identify central obesity and cardiometabolic risk in children and adolescents globally, thus allowing international comparison across populations.

Project description:The growth of children is an indicator of health and society's wellbeing. Growth references are useful in monitoring a child's growth, which is a very important part of child care. Poland's growth references are not updated regularly. Although several growth reference ranges have been developed in Poland over recent years, sampling was restricted to urban populations of major cities. The aim of this study was to assess how well Polish children match with, or diverge from, regional charts and to compare them with international growth references.Four Polish and two international (WHO 2007 and USCDC2000) growth references were used to calculate the height, weight and BMI z-scores in a recent, large, population-representative sample of school-aged children and adolescents in Poland. The distributions of z-scores were analysed with descriptive and inferential statistical methods.Mean height z-scores calculated with the use of the WHO 2007 and USCDC2000 references were positive and significantly different from zero over the entire age range. The mean height z-score was closest to zero in the Poznan reference for boys (0.05) and Warszawa reference for girls (0.01). Median weight z-scores were positive under all weight references over the entire age range with only the exception of 18-year-old girls' weight z-score calculated relative to USCDC2000. Median BMI z-scores were positive in males in early childhood, decreasing with age. In the case of girls, the median BMI z-score calculated using WHO 2007 and USCDC2000 was close to zero in early childhood, decreased in adolescents and reached minimum values at age 18 years. Median BMI z-scores calculated with the use of the Lodz reference fluctuated between 0.05 and 0.2 over the studied age range.In this contemporary sample of Polish school-aged children, distributions of height, weight and BMI differed from those of children from the international growth references. These differences should be considered when using the references. There exist certain limitations to the analysis of height, weight, and BMI z-scores when Polish regional references are used.

Project description:Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015-2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755-0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694-0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828-0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876-1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.

Project description:The prevalence of pediatric hypertension and obesity has increased over the past decades. Pediatric hypertension and obesity are associated with adult hypertension, metabolic syndrome, and cardiovascular disease. There are two main pediatric blood pressure (BP) classification guidelines, the "Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents" (AAP 2017) and "2016 European Society of Hypertension guidelines for the management of high BP in children and adolescents" (ESH 2016). No study has classified Korean youths with cardiometabolic risk. This study analyzed the prevalence of high BP according to AAP 2017 (elevated BP and hypertension) and ESH 2016 (prehypertension and hypertension) in Korean children. Additionally, the cardiometabolic risk factors (CMRFs) were compared between children who were hypertensive in AAP 2017 but normotensive in ESH 2016 (upward reclassified) to those who were normotensive in both AAP 2017 and ESH 2016. Data were extracted from the Korea National Health and Nutrition Examination Survey, 2016-2018. A total of 1,858 children aged 10-17 years were included in the analysis. The prevalence of elevated BP/prehypertension and hypertension was 4.1 and 6.5% by ESH 2016, and 8.9 and 9.4% by AAP 2017 in Korean youth, respectively. The AAP 2017 reclassified 11.9% of youth in the upper BP class. When those upward reclassified youth were compared to those who were normotensive in both AAP 2017 and ESH 2016, reclassified youth were male predominant (77.1 vs. 49.6%, p < 0.001), older (14.6 vs. 13.8, p < 0.001) and showed higher body mass index (BMI) z-score (0.77 vs. 0.15, p < 0.001) and more overweight/obesity (14.0/30.6 vs. 13.3/6.4%, p < 0.001) and severe CMRFs (triglyceride 83.2 vs. 72.9 mg/dL, p = 0.011; high-density lipoprotein cholesterol 47.3 vs. 51.1 mg/dL, p < 0.001; alanine transaminase 21.7 IU/L vs. 14.7 IU/L, p = 0.001, uric acid 5.89 vs. 5.22 mg/dL, p < 0.001; metabolic syndrome 13.2 vs. 1%, p < 0.001). In conclusion, AAP 2017 showed a higher prevalence of abnormal BP in Korean youth, and those upward reclassified by AAP 2017 were more obese and had severe CMRFs than normotensive Korean children. The AAP 2017 could allow the early detection of Korean youth with more CMRFs.

Dataset Information

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

Publications

Establishing International Blood Pressure References Among Nonoverweight Children and Adolescents Aged 6 to 17 Years.

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