Exploring Overweight Risk Trajectories During Childhood and Their Associations With Elevated Blood Pressure at Late Adolescence: a Retrospective Cohort Study

Abstract

Background: Overweight during childhood is significantly associated with higher risk of high blood pressure (HBP) in later life. However, recognition of critical intervention period is limited. We aimed to analyze the changes in overweight risk during school-age and its relationship with HBP. Methods: Seventeen thousand eight hundred sixteen school-aged children (53.9% boys) with a mean follow-up time of 8.2 years were involved. Children’s overweight was defined as body mass index Z score ≥1 and was fitted with a group-based trajectory model. The 4 trajectories were labeled as constant low, high decreasing, low rising, and constant high according to the change of overweight risk during follow-up. Population-averaged logit model and log-binomial regression models were used to analyze HBP risk. Cox proportional hazard model was used to analyze the HBP incidence among distinct groups. Results: Children with higher overweight risk generally had higher HBP risk during follow-up. However, the HBP risk in low rising group was low at baseline and increased to 3.14 (95% CI, 2.54–3.88; P <0.001) for boys and 3.23 (95% CI, 2.08–5.01; P =0.004) for girls at end point, which were comparable to the relative risk in the constant high group (4.60 [95% CI, 4.02–5.27] for boys and 5.28 [95% CI, 3.94–7.07] for girls). Conclusions: Findings of this study provide insights on patterns of overweight risks during childhood. Children with transition from normal to overweight during teen years would be high-risk in HBP incidence.

Distinct Trajectories of Overweight During Childhood and Elevated Blood Pressure at Late Adolescence

“…In this issue, Wang et al 7 conducted a longitudinal cohort study of 17 810 children (7 to 18 years of age) to identify trajectories of the overweight risk and their associations with the risk of HBP. All data were acquired during annual physical examinations taking place in elementary and high schools in the city of Zhongshan in China between 2005 and 2016.…”

Change of weight status during school age and its association with late adolescent blood pressure: Results from a 15-year longitudinal study in China

“…Previous studies of our team, on the basis of populationbased analysis, found that children who started overweight during pubertal height growth had higher risk of HBP at late adolescence, compared to those who remained overweight during school-age (13). In the present analysis with individualbased exploration, we confirmed the previous findings, and further found that returning from obese to overweight, as well as from overweight to normal weight, would both lead to decreased SBP and DBP were displayed as mean ± standard error; HBP was displayed as number (%).…”

“…Pooled cohort study found that greater obesity duration was associated with worse blood pressure outcomes in mid-adulthood (11). Retrospective cohort studies from China and the United States found that both children who maintained a high level of body mass index (BMI) and those who transit from non-obese to obese status during childhood and adolescence would experience elevated hypertension risk during follow-up (12)(13)(14). Population-based studies also found that the peak of hypertension and weight status transition both occurred around the age of growth spurt, (13,15) while pooled analysis found that the prevalence of hypertension peaked at 7.89% among those aged 14 years (7).…”

“…Retrospective cohort studies from China and the United States found that both children who maintained a high level of body mass index (BMI) and those who transit from non-obese to obese status during childhood and adolescence would experience elevated hypertension risk during follow-up (12)(13)(14). Population-based studies also found that the peak of hypertension and weight status transition both occurred around the age of growth spurt, (13,15) while pooled analysis found that the prevalence of hypertension peaked at 7.89% among those aged 14 years (7). However, most of the previous studies were conducted on the basis of population study; individualized analysis of weight change on high blood pressure (HBP) risk was still limited.…”

Ecological system theory and community participation to promote healthy food environments for obesity and non-communicable diseases prevention among school-age children

“…Previous studies (7)(8)(9) have clearly indicated that the causes of obesity are multifactorial and complex. The incidence of obesity among school-age children cannot be explained based on the behavioural factors of students alone; rather, the environmental conditions surrounding students could also influence students' health-related behaviours (10)(11)(12) .…”