|The relation of body mass index and blood pressure in Iranian children and adolescents aged 7-18 years old.|
|Jump to Full Text|
|PMID: 23113046 Owner: NLM Status: PubMed-not-MEDLINE|
|BACKGROUND: The obesity and hypertension are the major risk factors of several life threatening diseases. The present study was aimed to investigate the relation between body mass index (BMI) the validated index of adiposity and different aspect of blood pressure (BP).
METHODS: Systolic and diastolic blood pressures and also weight and height of 7 to 18 years old children and adolescent collected in 2002 and 2004 respectively. Data was consisted of 14865 schoolchildren and adolescents from representative sample of country. BMI was classified according to CDC 2000 standards into normal (BMI<85th percentile), at risk of overweight (BMI≥85th and <95th percentile) and overweight (BMI≥95th percentile). Then, age-sex specific prevalence of being overweight was derived. ANOVA was used to investigate the effect of BMI on systolic blood pressure and diastolic blood pressure and mean arterial pressure of participants.
RESULTS: Mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure (MAP) significantly increased with BMI (P< 0.0001) and age groups (P< 0.0001), and was significantly (P< 0.0001) higher in boys than girls especially in older ages. (P< 0.0001, interaction of age and BMI level). The proportion of being overweight was significantly higher in boys than girls was (7.4% vs. 3.6%; P< 0.0001).
CONCLUSION: There is an association between BP and BMI in children and adolescence. SBP, DBP and MAP are associated with rise in BMI and age, which was lower in girls. This data can provide basics for public health policy makers and primary prevention policies in the country.
|M Hosseini; N Ataei; A Aghamohammadi; M Yousefifard; Sh Taslimi; F Ataei|
Related Documents :
|2968786 - Fibrinogenolysis in the absence of fibrin formation in severe hypobaric hypoxia.
11591616 - Dysregulation of peripheral and central chemoreflex responses in chagas' heart disease ...
24155846 - Prevalence and control of hypertension in a niger delta semi urban community, nigeria.
232966 - Effect of arterial hypoxia on the cerebrocortical redox state, vascular volume, oxygen ...
21673666 - Helium penetrates into silica glass and reduces its compressibility.
3436866 - Respiratory effects of a patent ductus arteriosus in premature newborn lambs.
|Type: Journal Article Date: 2010-12-31|
|Title: Iranian journal of public health Volume: 39 ISSN: 2251-6085 ISO Abbreviation: Iran. J. Public Health Publication Date: 2010|
|Created Date: 2012-10-31 Completed Date: 2012-11-01 Revised Date: 2013-05-30|
Medline Journal Info:
|Nlm Unique ID: 7505531 Medline TA: Iran J Public Health Country: Iran|
|Languages: eng Pagination: 126-34 Citation Subset: -|
|Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.|
|APA/MLA Format Download EndNote Download BibTex|
Journal ID (nlm-ta): Iran J Public Health
Journal ID (iso-abbrev): Iran. J. Public Health
Journal ID (publisher-id): IJPH
Publisher: Tehran University of Medical Sciences
Copyright © Iranian Public Health Association & Tehran University of Medical Sciences
Received Day: 28 Month: 3 Year: 2010
Accepted Day: 30 Month: 10 Year: 2010
Electronic publication date: Day: 31 Month: 12 Year: 2010
collection publication date: Year: 2010
Volume: 39 Issue: 4
First Page: 126 Last Page: 134
PubMed Id: 23113046
Publisher Id: ijph-39-126
|The Relation of Body Mass Index and Blood Pressure in Iranian Children and Adolescents Aged 7–18 Years Old|
1Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2Dept. of Pediatric Nephrology, the Children’s Hospital Medical Center, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3Dept. of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4 Tehran University of Medical Sciences, Tehran, Iran
5Dept. of Pediatric Nephrology, The Children’s Hospital Medical Center, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
|*Corresponding author: Tel: +98 21 88989125, Fax: +98 21 88989127, E-mail: firstname.lastname@example.org
The obesity is known as one of the most important health problems. Its prevalence is increasing rapidly in all ages including children all over the world (1–3). Obesity is usually defined by the BMI, which provides an index of weight relative to height and is generally considered a valid index of adiposity (4). Obesity is considered as a gateway disease, which can lead to heterogeneous diseases such as metabolic syndrome, diabetes different gastrointestinal and respiratory disease, and certain type of cancers and hypertension (HTN) (5–7).
Hypertension is believed as a significant risk factor of adulthood diseases and unfortunately is getting more prevalent rapidly (6). HTN is associated with the incidence of stroke, coronary heart disease, congestive heart failure and renal insufficiency (8). It has been shown that high BP in adults can be originated from childhood period (7, 9). Therefore, preventive intervention during early life might reduce the burden of the disease (9).
Several studies have declared that there is a relation between HTN and adiposity (5, 10–12). It is observed that the level of BP and prevalence of high BP is higher in the overweight and obese children and adolescents (1). Several studies around the world have found the relation between BMI and high BP in school-aged adolescents (4, 13, 14). Two studies in Iran also found similar results for Iranian children and adolescents (9, 15).
This study aimed to investigate the association between BMI and BP with respect to age and gender among Iranian children and adolescent 7 to 18 yr old. This is the first study looking at this relation on a representative sample of population in Iran.
Data on systolic and diastolic blood pressures and also weight and height from a sample of 8,848 primary school children aged 7–12 yr old [4,476 girls (50.6%) and 4,372 boys (49.4 %)] which was collected in 2002 combined with similar data gathered in 2004 on 6017 guidance and secondary school children aged 12–18 yr old [2,571 (45.7%) girls and 3,266 (54.3%)] in Tehran, as a representative of Iran (9, 16), to investigate the relation of BMI and BP.
Tehran is the capital city of Iran and is divided into 20 regions for administrative purposes. In both studies, in each region of the city, one all boys’ school and one all girls’ school were randomly selected from the list of schools. Trained medical staff measured systolic and diastolic pressures, weight, and height of healthy children and adolescent and rounded it to the nearest mmHg, kilogram, and centimeter, respectively. The criteria for being healthy and full detail of procedure of measurement of BP and weight as well as height are reported elsewhere (9, 16). Exact age of children was obtained from student identification cards and recorded in complete years.
CDC 2000 standards (17) were used to classify BMI of children and adolescents into three groups according to their sex and age (BMI<85th percentile where considered as normal, BMI≥85th and <95th percentile as at risk for overweight and BMI≥95th percentile as overweight (which also contains obese children) (9). Then, age-sex specific prevalence of overweight was derived. The chi-squared test was used to compare the proportion of different BMI categories in boys and girls. The effect of BMI on SBP and DBP and MAP of Iranian children and adolescents was investigated using ANOVA. Data were analyzed using STATA 9.0. P value less than 0.05 was considered significant in all analyses.
Systolic and diastolic blood pressure (mmHg) together with weight (kg) and height (cm) of 14,865 of healthy Iranian children and adolescents aged 7–18 yr old used for this study. Of these 7,635 (51.4%) were male and 7,230 (48.6%) were female. Body Mass Index was computed as weight/height2 after rescaling height from centimeter to meter. Specific age-sex mean (±SD) of BMI, SBP and DBP are presented in Table 1. As Table 1 indicates both for boys and girls mean of BMI, SBP and DBP increases with age and is higher in boys (P< 0.0001). Weighted average of BMI difference (according to their sample sizes at each age group) of boys and girls was 0.37 kg/mt2. These differences for SBP and DBP were 2.3 mmHg and 0.7 mmHg, respectively.
The percentages of normal weight children (BMI<85th percentile), children at risk for overweight (BMI 85th to 94th percentile) and overweight (BMI≥95th percentile) for each age group are presented in Table 2. Overall, 84.0% of the children weighted normal, 10.4% were at risk for overweight, and 5.6% were overweight. The chi-squared test showed that the proportion of being overweight was significantly higher in boys than girls was (7.4% vs. 3.6%; P< 0.0001) and was significantly higher in older age groups of boys than girls (P< 0.001).
For boys, girls, and each category of BMI, the mean (±SD) of SBP were computed and presented in Table 3. Analysis of variance (ANOVA) showed that the mean of SBP significantly increases with BMI rise and age in each BMI groups, although SBP rise is significantly higher in boys (P< 0.0001; Table 3).
The mean of DBP values for each BMI and age groups are shown for boys and girls separately in Table 4. As this Table shows the mean of DBP is also increases with BMI and age for boys and girls. Analysis of variance showed that mean DBP significantly increases with age (P< 0.0001) and BMI group (P< 0.0001), and was significantly (P< 0.0001) higher in boys than girls especially in older ages. (P< 0.0001, interaction of age and BMI level; Table 3 and 4).
Table 5 provides the MAP for both sexes according to each age and BMI groups. As same as SBP and DBP, the MAP significantly increases with age and BMI and is higher in boys than girls. Moreover, the amount of this increase is higher in older age group of boys than girls (P< 0.0001).
This study assessed the association between BMI and BP among Iranian children and adolescents 7 to 18 yr old. This study indicates that elevated BP is more prevalent among overweight healthy children and adolescents. We demonstrated that the mean of SBP, DBP and MAP are significantly associated with increase in amount of BMI that is detectable in all age groups. Furthermore, in an ecological view, an increase in age is associated with increase in BP and Iranian boys have higher BP compared with their girls’ peers respecting each age and BMI groups. In this study, data was collected from different located primary, guidance, and high schools of Tehran and it was assumed the representative sample of Iranian children and adolescents (18). We collected the data from all 20 regions of Tehran. Analysis was performed on 14,865 individual that are unique in whole country until now. As data resulted from sampling from different schools in Tehran, the effect of clustering on finding was also considered. We calculated intraclass correlation that was 0.182, 0.132 and 0.183 for systolic, diastolic and MAP, respectively. Moreover, when intraclass correlation is less than 0.5, the findings in ANOVA and estimation of standard deviations would barely differ without cluster data consideration (19).
Previous studies in consistent with our study have reported a significant association between BMI and BP (14, 20–25). Hernandez et al. also confirmed a positive relation between BMI and BP (26). A prospective cohort study hold on 22071 individuals in Harvard school revealed positive relation between BMI and BP (27). Cindy et al. also supported that BMI and BP are related together (28) Two studies about obese children with normal clinical BP showed a high prevalence of elevated ambulatory BP in comparison to their leaner counterparts (29, 30). Two studies in Iran and Turkey expressed association between BMI and BP. Despite the fact that the last two studies in Iran and Turkey were only based on small numbers of children compared with our study (15, 31). All findings from the above studies supported our result in this survey.
The impact of gender on the association of BMI and BP is controversial. Outcome obtained from study conducted in Quebec, Canada in adolescents aged 12–18 yr remarked that intra-abdominal fat have direct relation with BP which was less prominent in girls (32). Ataei et al. also showed higher BMI in less than 7 yr old boys than their girls’ counterparts in a sample of 3186 children from Tehran (9). In contrast to woman, Chen et al. observed a linear relation between the 2 yr BMI changes and HTN development among men. This relation only observed in menopause women (33). On the other hand, Zuhal et al. reported that sex had no effect on BMI and BP relation (4). Our study suggests that association between BMI and BP is more considerable in boys. Probable reason of different BP trend in men and women can come from effect of sex hormone in sodium excretion and renal homodynamic response to salt. Regarding that, women have higher sensitivity to sodium intake after menopause (34).
In the present study, 10.4% children and adolescents were at risk for overweight and 5.6% were overweight. In general, similar to BP, BMI was significantly higher in boys than girls. A survey in Turkey in 2004, which was conducted on 15 to 18 yr old adolescents, found that approximately 3% were overweight and 11% were at risk for overweight (31). Another study conducted on 1899 children 6 to 14 yr old in turkey in 2002 recognized that higher percent of boys than girls lay at or above 85 percentile of BMI (4). Cynthia et al. in USA also reported that boys have higher percentage in overweight, obesity, and risk for obesity groups than girls do in both 1999–2000 and 2007–2008 surveys (35, 36). Unlike our result, Kimani et al. showed that rural South Africa 10 to 20 yr old girls have higher prevalence of obesity and overweight than boys in a 2007 survey (37). The result of this study about increasing BMI with age is consistent with several studies. A study in California in 2004, which studied 5 to 15 yr old children and adolescents, showed that BMI increases with age (28). Aayatollahi et al. with creases with age (28). Aayatollahi et al. with studying on 2,397 children aged 6.5 to 11.5 yr old showed that BMI increased with age (38).
High BMI and elevated BP are among the important risk factors of cardiovascular disease, diabetes mellitus, HTN and dyslipidemia (9, 28, 39–42). Childhood BP predicts risk of cardiovascular disease in adulthood period and concomitant high BMI with elevated BP increase risk of cardiovascular disease (23). Dealing with high BMI and elevated BP can help to prevent the upcoming threats in adulthood period through public health policies as both high BMI and elevated BP are considerable risk factor for such diseases (43–45).
In conclusion, we have demonstrated that there was an association between blood pressure and body mass index in children and adolescents. We showed that SBP, DBP and MAP are associated with rise in BMI and age in the society. Generally, BP was lower in girls than boys in age range we studied were. This data can provide basics for public health policy makers to estimate the risk of cardiovascular disease through BMI and BP estimates of children and adolescence. This data can also be used for primary prevention policies in the country.
All ethical issues including plagiarism, Informed Consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc have been completely observed by the authors.
The authors would like to thank the sponsorship of Tehran University of Medical Sciences for this study. (Grant NO. 1354). In addition, the first author would like to thank Miss T. Azadi and N. Motamedi for their help in searching literature for preliminary draft of this paper. The authors declare that they have no conflicts of interest.
|1..||Flores-Huerta S,Klunder-Klunder M,Reyes de la Cruz L,Santos JI. Year: 2009Increase in body mass index and waist circumference is associated with high blood pressure in children and adolescents in Mexico cityArch Med Res4032081519427973|
|2..||Klein S,Wadden T,Sugerman HJ. Year: 2002AGA technical review on obesityGastroenterology123388293212198715|
|3..||Nesbitt SD,Ashaye MO,Stettler N,Sorof JM,Goran MI,Parekh R,et al. Year: 2004Overweight as a risk factor in children: a focus on ethnicityEthn Dis Winter14194110|
|4..||Gundogdu Z. Year: 2008Relationship between BMI and blood pressure in girls and boysPublic Health Nutr11101085818426632|
|5..||Li L,Law C,Power C. Year: 2007Body mass index throughout the life-course and blood pressure in mid-adult life: a birth cohort studyJ Hypertens25612152317563534|
|6..||Nielsen GA,Andersen LB. Year: 2003The association between high blood pressure, physical fitness, and body mass index in adolescentsPrev Med3622293412590998|
|7..||Raj M,Sundaram KR,Paul M,Sudhakar A,Kumar RK. Year: 2010Body mass index trend and its association with blood pressure distribution in children [in press]J Hum Hypertens1117|
|8..||Lauer RM,Clarke WR. Year: 1989Childhood risk factors for high adult blood pressure: the Muscatine StudyPediatrics844633412780125|
|9..||Ataei N,Hosseini M,Iranmanesh M. Year: 2009The relationship of body mass index and blood pressure in Iranian children <7 yr oldJ Trop Pediatr555313719297341|
|10..||Kotsis V,Stabouli S,Bouldin M,Low A,Toumanidis S,Zakopoulos N. Year: 2005Impact of obesity on 24-hour ambulatory blood pressure and hypertensionHypertension45602715723966|
|11..||Mahamat A,Richard F,Arveiler D,Bongar V,Yarnell J,Ducimetie‘ ree P,et al. Year: 2003Body mass index, hypertension and 5-year coronary heart disease incidence in middle aged men: the PRIME studyJ Hypertens2135192412640245|
|12..||Tesfaye F,Nawi N,Van Minh H,Byass P,Berhane Y,Bonita R,et al. Year: 2007Association between body mass index and blood pressure across three populations in Africa and AsiaJ Hum Hypertens21283717066088|
|13..||Agyemang C,Oudeman E,Zijlmans W,Wendte J,Stronks K. Year: 2009Blood pressure and body mass index in an ethnically diverse sample of adolescents in Paramaribo, SurinameBMC Cardiovasc Disord9192819460143|
|14..||Sanchez-Zamorano LM,Salazar-Martinez E,Anaya-Ocampo R,Lazcano-Ponce E. Year: 2009Body mass index associated with elevated blood pressure in Mexican school-aged adolescentsPrev Med4865434819286003|
|15..||Behjati M,Barkhordari K,Lookzadeh MH. Year: 2006The Relation between blood pressure and body mass index in iranian school age childrenIran J Med Sci March311336|
|16..||Ataei N,Aghamohammadi A,Yousefi E,Hosseini M,Nourijelyani K,Tayebi M,et al. Year: 2004Blood pressure nomograms for school children in IranPediatr Nephrol192164814685836|
|17..||Kuczmarski RJ,Ogden CL,Guo SS,Grummer-Strawn LM,Flegal KM,Mei Z,et al. Year: 2002CDC Growth Charts for the United States: methods and development 2000Vital Health Stat2461190|
|18..||Hosseini M,Carpenter RG,Mohammad K. Year: 1998Growth of childeren in IranAnn Hum Biol253249619624463|
|19..||Hosseini M,Carpenter RG,Mohammad K. Year: 1998Growth charts for IranAnn Hum Biol253237479624462|
|20..||Chiolero A,Bovet P,Paradis G,Paccaud F. Year: 2007Has blood pressure increased in children in response to the obesity epidemic?Pediatrics11935445317332208|
|21..||Chiolero A,Madeleine G,Gabriel A,Burnier M,Paccaud F,Bovet P. Year: 2007Prevalence of elevated blood pressure and association with overweight in children of a rapidly developing countryJ Hum Hypertens212120717136104|
|22..||Falkner B,Gidding SS,Ramirez-Garnica G,Wiltrout SA,West D,Rappaport EB. Year: 2006The relationship of body mass index and blood pressure in primary care pediatric patientsJ Pediatr148219520016492428|
|23..||Rademacher ER,Jacobs DR Jr,Moran A,Steinberger J,Prinease RJ,Sinaiko A. Year: 2009Relation of blood pressure and body mass index during childhood to cardiovascular risk factor levels in young adultsJ Hypertens2717667419633567|
|24..||Salvadori M,Sontrop JM,Garg AX,Truong J,Suri RS,Mahmud FH,et al. Year: 2008Elevated blood pressure in relation to overweight and obesity among children in a rural canadian communityPediatrics1224e821e918829779|
|25..||Vlajinac H,Milju SD,Adanja B,Marinković J,Sipeti S,et al. Year: 2003Blood pressure levels in 7 to 14-year-old Belgrade childrenJ Hum Hypertens1711761514578915|
|26..||Hernandez M,Briceño S,Stepenka V,Mendoza Z,Labastidas N,Gonzalez K,et al. Year: 2009Realation between body mass andex and blood pressure in adolescentsEur J Intern Med20SS183|
|27..||Gelber RP,Gaziano JM,Manson JE,Buring JE,Sesso HD. Year: 2007A prospective study of body mass index and the risk of developing hypertension in menAm J Hypertens2043707717386342|
|28..||Wolff C,Hoang S,Flannery D,Wermuth L. Year: 2006A preliminary study of diet, overweight, elevated blood bressure, and acanthosis Nigricans among K-9th grade native American studentsCalifornian J Health Promot44778|
|29..||Aguilar A,Ostrow V,De Luca F,Suarez E. Year: 2010Elevated ambulatoryblood pressure in a multi-ethnic population of obese children and adolescentsJ Pediatrics15669305|
|30..||Maggio AB,Aggoun Y,Marchand LM,Martin XE,Herrmann F,Beghetti M,et al. Year: 2008Associations among obesity, blood pressure, and left ventricular massJ Pediatrics152448993|
|31..||Dinç G,Saatli G,Baydur H,Özcan C. Year: 2009Hypertension and overweight among Turkish adolescents in a city in Aegean region of Turkey: a strong relationship in a population with a relatively low prevalence of overweightAnadolu Kardiyol Derg94505619965314|
|32..||Syme C,Abrahamowicz M,T Leonard G,Perron M,Richer L,Veillette S,et al. Year: 2009Sex differences in blood pressure and its relationship to body composition and metabolism in adolescenceArch Pediatr Adolesc Med16398182519736335|
|33..||Chen PC,Sung FC,Su TC,Chien KL,Hsu HC,Lee YT. Year: 2009Two-year change in body mass index and subsequent risk of hypertension among men and women in a Taiwan communityJ Hypertens2771370619412132|
|34..||Pechère-Bertschi A,Burnier M. Year: 2004Female sex hormones, salt, and blood pressure regulationAm J Hypertens17994100115485766|
|35..||Ogden CL,Carroll MD,Curtin LR,Lamb MM,Flegal KM. Year: 2010Prevalence of high body mass index in US children and adolescents, 2007–2008JAMA303324220071470|
|36..||Ogden CL,Flegal KM,Carroll MD,Johnson CL. Year: 2002Prevalence and trends in overweight among US children and adolescents, 1999–2000JAMA2881417283212365956|
|37..||Kimani-Murage EW,Kahn K,Pettifor JM,Tollman SM,Dunger DB,Gómez-Olivé XF,et al. Year: 2010The prevalence of stunting, overweight and obesity, and metabolic disease risk in rural South African childrenBMC Public Health1011320043862|
|38..||Ayatollahi SMT,Mostajabi F. Year: 2006Body mass index reference data fir Shiraz (South of Iran) school children in reation to CDC standardsIranian Red Crescent Medical Journal84815|
|39..||Arslanagic E. Impact of health education intervention on the change of blood pressure and body mas index in adult participants in dreams project 1 [MPH thesis] School of Public Health. University of North Texas. USA. Year: 2008|
|40..||Csernus K,Lanyi E,Erhardt E,Molnar D. Year: 2005Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretionEur J pediatr164144915517379|
|41..||De Vito E,La Torre G,Langiano E,Berardi D,Ricciardi G. Year: 1999Overweight and obesity among secondary school children in Central ItalyEur J Epidemiol1576495410543355|
|42..||Mokdad AH,Ford ES,Bowman BA,Dietz WH,Vinicor F,Bales VS,et al. Year: 2003Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001JAMA289176912503980|
|43..||Harrison W,Marshall T. Year: 2006The epidemiology of blood pressure in East AsiaJ Hum Hypertens20979916251999|
|44..||Minh HV,Byass P,Chuc NT,Wall S. Year: 2006Gender differences in prevalence and socioeconomic determinants of hypertension: findings from the WHO STEPs survey in a rural community of VietnamJ Hum Hypertens2021091516195706|
|45..||Zhou M,Offer A,Yang G,Smith M,Hui G,Whitlock G,et al. Year: 2008Body mass index, blood pressure, and mortality from stroke: a nationally representative prospective study of 212,000 Chinese menStroke393753918239175|
Keywords: Blood pressure, Body mass index (BMI), Relation, Children, Adolescents.
Previous Document: Backpack weight and musculoskeletal symptoms in secondary school students, tehran, iran.
Next Document: Validation of a Persian Version of the Oral Health Impact Profile (OHIP-14).