Performance of obesity indices for screening elevated blood pressure in pediatric population

Ma, Chunxiao; Wang, Rui; Liu, Yue; Lu, Qiang; Lü, Na; Tian, Yiming; Liu, Xiaoli; Yin, Fei

doi:10.1097/md.0000000000004811

Cited by 21 publications

(28 citation statements)

References 41 publications

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“…ROC curve analysis in the present study also confirmed that BMI had comparatively better screening potential for hypertension risk in children. This is similar to the findings in a recent study by Ma et al 31 , who demonstrated that WC and WSR were no better than BMI to identify the risk of hypertension in children. However, Liang et al 32 showed a similar discriminatory capacity of BMI, WC and WSR for hypertension risk.…”

Section: Discussionsupporting

confidence: 91%

Comparison of adiposity measures in the identification of adolescents with hypertension

Roy

Ghosh

2019

Sri Lanka J Child Health

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Background: Hypertension in children is becoming a growing heath problem, with increasing prevalence.Objectives: To examine the relationship of body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), waist stature ratio (WSR) and conicity index (CI) with blood pressure and to differentiate the screening potential of BMI, WC, WHR, WSR and CI for the presence of hypertension in children. Method:A school-based cross-sectional study was carried out in 2017 on 13-16 year old Bengali children in two schools (a boys' school and a girl's school) from Howrah city, West Bengal where stature (ST), weight (WT), WC and hip circumference (HC) were measured, and BMI, WHR, WSR and CI calculated. Schools were randomly selected from the list of affiliated schools under the West Bengal Board of Secondary Education. All 13-16 year old children from the two schools were recruited after obtaining informed consent from parents and assent from the children. Children with pre-existing serious illnesses and deformities were excluded from the study. Bio-social information was obtained using an open-ended schedule. Age was obtained from the school register. Hypertension was defined as age and stature adjusted systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) ≥95 th percentile. Partial correlations, logistic regressions and area under the receiver operating characteristic curves (AUC) were estimated to understand the relationship of adiposity measure with blood pressure and hypertension. The authors declare that there are no conflicts of interest Funding: Research scholar is getting UGC fellowship from Visva-Bharati, Govt. of India Open Access Article published under the Creative Commons Attribution CC-BY LicenseResults: A total of 535 adolescents, comprising 282 boys and 253 girls aged 13-16 years, participated in this study. There was no statistically significant sex difference in age. Overall prevalence of hypertension was 8.5%. All adiposity measures were positively correlated with blood pressures. Logistic regression showed that BMI had the strongest associations with hypertension in both sexes. The AUC for BMI (0.82, 95% CI 0.751 to 0.895) was higher than those of other adiposity measures in assessing hypertension in boys. However, in girls, both BMI (AUC 0.75, 95% CI 0.644 to 0.856) and WSR (AUC 0.75, 95% CI 0.638 to 0.865) had similar higher assessment ability for hypertension compares to other measures.Conclusions: BMI had the highest odds ratio for hypertension, and was the best adiposity measure to assess hypertension.

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Section: Discussionsupporting

confidence: 91%

Comparison of adiposity measures in the identification of adolescents with hypertension

Roy

Ghosh

2019

Sri Lanka J Child Health

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“…Regarding the capacity to identify elevated BP, we found that BMIZ and WCZ performed better than WHtR (P < 0•04) in predicting elevated BP. This finding is consistent with recent studies in children (7-15 years old) in Tianjin, China (30) , and adolescents (12-17 years old) in Sarawak, Malaysia (29) , and with a previous meta-analysis of studies in children and adolescents (33) . However, in another study of children (6-10 years old) in Guangzhou, China, Liang (2015) found that WC was the best indicator to identify elevated BP (34) .…”

Section: Elevated Blood Pressuresupporting

confidence: 93%

The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children

et al. 2020

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BMI, waist circumference (WC) and waist-to-height ratio (WHtR) can be used for discriminating children and adolescents at risk of CVD. However, consensus on how to use these anthropometric indicators is lacking for children and adolescents in Asia. Discrete criteria are promoted internationally, but continuous variables could be used. Data from a survey of 10 949 Vietnamese school-aged children (6–18 years) were used to evaluate the performance of anthropometric indicators to identify elevated blood pressure (BP), dyslipidaemia or at least three cardiovascular risk factors (CVRF). Weight, height, WC and BP were measured using standardised protocols; 1009 participants who had blood lipids were analysed. AUC was used to assess the performance, and the Youden index to identify optimal cut-offs. The prevalence of elevated BP, dyslipidaemia and CVRF was 26·5, 49·3 and 12·2 %, respectively. BMI, WC and WHtR had low capacity to identify elevated BP and dyslipidaemia (AUC range 0·61–0·66) but moderate capacity to identify CVRF (0·72–0·74). Optimal BMIZ cut-offs to identify elevated BP, dyslipidaemia and CVRF were 0·40, 1·01 and 1·1 sd; for WC z-score, they were 0·06, 0·49 and 0·62 sd; for WHtR, optimal cut-offs were close to 0·5. A BMIZ cut-off of 1·0 sd and a WHtR cut-off of 0·5 would, therefore, be useful criteria to identify Vietnamese children who are likely to have CVRF. However, further validation of these criteria in other studies of Asian children and adolescents is needed.

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“…Contrary to adult data, available results in children and adolescents are inconclusive, with some studies reporting similar results as in adults, ie WC/H being a better predictor of risk of metabolic disorders, while others did not find statistically significant differences among WC/H index and BMI or WC . Notwithstanding this inconsistency, the use of WC/H as a putative anthropometric health marker in youth is important because children and adolescents undergo significant body‐shape transformations due to growth, developmental, and maturational processes .…”

Section: Introductionmentioning

confidence: 92%

“…11 Some studies among adults have demonstrated that the WC/H index is useful as a screening tool for obesity and related metabolic disorders, 6,12,13 and a cut-point of 0.5 seems to be a suitable boundary value to identify subjects at risk of metabolic disorders, independent of sex and ethnicity. 6,12 Contrary to adult data, available results in children and adolescents are inconclusive, [14][15][16] with some studies reporting similar results as in adults, ie WC/H being a better predictor of risk of metabolic disorders, 14 while others did not find statistically significant differences among WC/H index and BMI or WC. 15,16 Notwithstanding this inconsistency, the use of WC/H as a putative anthropometric health marker in youth is important because children and adolescents undergo significant body-shape transformations due to growth, developmental, and maturational processes.…”

mentioning

confidence: 92%

Identifying the best body‐weight‐status index associated with metabolic risk in youth

Gomes

Nevill

Katzmarzyk

et al. 2018

Scandinavian Med Sci Sports

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This study investigated the association of six different anthropometric markers with metabolic syndrome to find the most suited to predict children at risk. Sample comprises 1324 Portuguese youth (701 girls, 623 boys), aged 10-17 years. Six anthropometric markers were included: body mass index (BMI), BMI z-score, tri-ponderal index (TPI), waist circumference (WC), WC/height ratio (WC/H), and WC/H adjusted ratio (WC/H ). A standardized metabolic risk score (zMR) was computed by summing of standardized values for fasting glucose, triglycerides, high-density lipoprotein cholesterol, and mean arterial blood pressure. The associations between zMR and anthropometric markers were assessed using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal values that best predict metabolic risk of each anthropometric marker. Among the studied predictors, BMI z-score, followed by BMI and WC, was most highly associated with zMR, while WC/H was the weakest predictor. ROC analyses showed significant AUCs for all markers, yet the discrimination was poor (AUCs from 0.60 to 0.68), with sensitivity ranging from 45.5% to 67.5% and specificity from 72.6% to 81.9%. The optimal cut-off values to predict metabolic risk were 1.62, 23.1 kg/m , 71.0 cm, 18.0 kg/m , 0.47, and 0.50, for BMI z-score, BMI, WC, TPI, WC/H, and WC/H , respectively. BMI z-score, followed by BMI and WC, were the most relevant anthropometric markers to predict metabolic risk in youth, while WC/H was the worst predictor. Results suggest that anthropometric markers should continue to be used as clinical tools to identify youth at risk.

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Performance of obesity indices for screening elevated blood pressure in pediatric population

Cited by 21 publications

References 41 publications

Comparison of adiposity measures in the identification of adolescents with hypertension

Comparison of adiposity measures in the identification of adolescents with hypertension

The utility of anthopometric indicators to identify cardiovascular risk factors in Vietnamese children

Identifying the best body‐weight‐status index associated with metabolic risk in youth

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